Operations Planning Specialist (PDP Oversight & Monitoring)

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

• Bachelor's Degree or equivalent experience.
• 3-4 years of relevant Medicare (Part D and/or Part C) or other government program experience in eligibility, premium billing or healthcare operations.
• Proficiency with Microsoft Word, Excel, Outlook, PowerPoint.
• Must be self-motivated and possess the competencies required to work in a fast-paced and heavily matrixed environment
• Ability to perform responsibilities independently as well as an effective team member
• Excellent conceptual and analytical skills with the ability to identify linkage between interfacing systems and processes, identify issues and manage/execute solutions to resolution.
• Strong problem solving skills and detail orientation. 
• Ability to analyze situations and is comfortable dealing with ambiguity.
• Capacity to learn process and product information quickly and efficiently.
• Excellent organizational and written/verbal communication skills.

• Knowledge of advanced Excel, report writing, and analysis activities.
• Enrollment and eligibility experience and process improvement is a plus.
• Medicare Advantage or Part D experience.

• →Support daily oversight and monitoring of PDP Enrollment & Premium Billing operations with the vendor, internal and external partners. Includes BPO vendor, Pharmacy Claim vendor (Express Scripts), and internal HCSC Business and matrix partners.
• →Perform ongoing review and interpretation of new and existing CMS requirements to ensure processes are compliant with CMS.
• →Monitor operational metrics, critical volumes, and daily inventory to proactively identify potential issues.
• →Review Service Level Agreement (SLA) on a monthly basis and work with vendor/matrix partners to address any issues impacting enrollment and billing operations
• →Manage weekly monitoring activities; pulling samples, tracking results and evidence of corrective action to support CPE audits, and prepare results reporting for leadership.
• →Perform focused monitoring/audits post deployment of changes to operational processes.
• →Participate in and actively support all internal, external, and CMS audit activities by quality reviewing universes, samples and all supporting documentation.
• →Identify and articulate trends and issues found in monitoring and work with business partners and vendor for remediation and/or process improvements.
• →Support additional duties and projects based on business needs such as AEP and 1/1 Readiness activities related to enrollment and billing.
• →Support Annual review of vendor policy & procedures to ensure processes are up to date and current with CMS guidance and Company Business policies.

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At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees.  Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

Flex employees are expected to be in the office a minimum of three days a week. Management will have discretion to modify an employee's weekly schedule for exigent circumstances.

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. We are a drug-free and smoke-free workplace. Employment may be contingent upon successful completion of drug screening in accordance with applicable law.

Exact compensation may vary based on skills, experience, and location.