Medical Vendor Oversight Specialist - TCC
Company: Accident Fund Holdings, Inc
Posted on: February 15, 2020
**Lansing or New Berlin** SUMMARY: The Medical Vendor Oversight
Specialist will provide day to day monitoring of vendor customer
service partnership to ensure the effectiveness of the TeleCompCare
(TCC) Program for Brand policyholders. This position will have a
wide variety of specialized functions in support of the TCC program
working with the TCC Manager and Brand Underwriters. Responsible
for generating, maintaining, analyzing and reporting the results of
TCC results and outcomes. Audits and monitors vendor performance
and compliance with the contract. Responsible for performing
administrative tasks which may be highly confidential and sensitive
in nature utilizing considerable independent judgment.
RESPONSIBILITIES/TASKS: Takes the lead on vendor issues following
submitted complaints and provide resolutions to meet internal
performance standards. Direct, communicate, assign and manage work
referred to vendors. Assist in implementing of new vendor services,
including communication and workflow/ processes. Develop and manage
vendor relationships including scheduling of meetings, greeting and
assisting vendors. Works closely with manager and brands on
implementation of new policyholders in the TCC Program. Inform
appropriate staff of issues as necessary. Analyzes trends and
reviews reports as requested or scheduled (i.e. metrics,
scorecards, compliance, cost center etc.). Prepares materials for
presentation to all customers while maintaining confidentiality.
Trains MMX team and internal customers on the use of the TCC
program. Evaluate and monitor TCC vendor based on service needs of
the brands and ensure customer service efforts are being met.
Responsible for ensuring vendor compliance to corporate standards
(i.e. timely submission, purchasing, timekeeping, licensing).
Conducts annual vendor audits as scheduled or on an as needed
basis. Make recommendations for metrics used to measure vendor
performance. Respond to calls, email communication and provides
information to vendors, insured, providers or routes calls to the
appropriate staff. Establishes and maintain effective working
relationships with all internal and external customers. Develop a
strong relationship and partnership with the claims department.
Assist in the development of team goals. This position description
identifies the responsibilities and tasks typically associated with
the performance of the position. Other relevant essential functions
may be required. EMPLOYMENT QUALIFICATIONS: EDUCATION: Bachelor's
degree in insurance, business or a related field required. Relevant
combination of education and experience may be considered in lieu
of degree. College level medical courses required. Continuous
learning, as defined by AFHI's learning philosophy, is required.
Certification or progress toward certification is highly preferred
and encouraged. CAWC highly preferred. EXPERIENCE: A minimum of two
years experience in an insurance organization or completion of
trainee program with demonstrated skills in the areas of medical
cost containment vendors, oversight of vendors, auditing and
contract review. Workers compensation experience preferred.
SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: Ability and proficiency
in the use of computers and company standard software specific to
position. Knowledge of workers' compensation laws and regulations,
including jurisdictional laws. Effective customer service skills.
Ability to negotiate, build consensus and resolve conflict. Ability
to manage multiple priorities and meet established deadlines.
Attention to detail and analytical skills. Ability to work
independently as well as within a team. Ability to work effectively
in a multi-functional business unit. Excellent oral and written
communication skills. Ability to comprehend consequences of various
situations and to make appropriate individuals aware of these to
facilitate decision making. Excellent organizational skills and
ability to prioritize work. Ability to proofread documents for
accuracy of spelling, grammar, punctuation, and format. Ability to
effectively exchange information clearly and concisely, present
ideas, report facts and respond to questions, as appropriate
Ability to provide customer service by responding appropriately to
inquiries or concerns from agents, policyholders, regulatory
agencies, management, and employees. Effective presentation skills
in a variety of settings. WORKING CONDITIONS: Work is performed in
an office setting with no unusual hazards. Minimal travel required
with occasional overnight stays. Work is required at various times
of the day and sometimes weekend work may be required. The
qualifications listed above are intended to represent the minimum
education, experience, skills, knowledge and ability levels
associated with performing the duties and responsibilities
contained in this job description. We are an Equal Opportunity
Employer. Diversity is valued and we will not tolerate
discrimination or harassment in any form. Candidates for the
position stated above are hired on an "at will" basis. Nothing
herein is intended to create a contract.
Keywords: Accident Fund Holdings, Inc, Lansing , Medical Vendor Oversight Specialist - TCC, Healthcare , Lansing, Michigan
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