ActiveCare Customer Success Consultant

Location: 1900 Aldrich Street... Austin, Texas, 78723 United States ActiveCare Customer Success Consultant Requisition ID: req1057 Employment Type: Unclassified Regular Full-Time (URF) Division: Health Operations Compensation: $70,276.00 - 87,845.00, Annual Salary Location: Alpha Building Job Closing: July 5th at 5:00 PM, CST Who We Are With the Health Division, you'll be joining a passionate team of self-motivated change agents united by our mission: driving to design the delivery of high-quality healthcare for nearly three-quarters of a million active and retired Texas public educators. The healthcare industry is complex and we're a team of problem-solvers who are up for the challenge. With a focus on innovation and collaboration to catalyze the market, we spend nearly $4 billion annually on healthcare to make a difference in our members' lives. With a career at TRS, you'll be empowered through a culture of continuous learning, front-line decision making, coaching and mentorship to shape the future of our work, while transforming healthcare delivery for 1 in 41 Texans. The TRS-ActiveCare Customer Success Consultant is responsible for the delivery of enrollment, eligibility, and customer service solutions to participating and non-participating schools districts interested in joining TRS-ActiveCare. The incumbent will serve as a subject matter expert for TRS-ActiveCare operations, provide operational support and service to participating and non-participating school districts, conduct research and analysis to provide updates to the Health leadership team, and assists with vendor and contract administration. This position proactively works cross-functionally with the Health staff and agency employees. This is a Hybrid position and requires 3 days of onsite work a week conducted at our TRS office in Austin, TX. What You Will Do Program Administration • Develops and implements improvement and enhancements, including plan provisions/exclusions based on medical necessity or experimental/investigational medical services. • Participates and delivers solutions in TRS-ActiveCare operational enrollment and eligibility functions, including Annual Enrollment, District on-boarding, district off-cycle , and member support of participating districts in TRS-ActiveCare. • Participates in projects and process improvements to deliver enrollment, eligibility, and customer service solutions to participating and non-participating school directs interested in joining TRS-ActiveCare. • Presents TRS-ActiveCare content in-person and virtually at school district events and professional organization events. • Reviews TRS-ActiveCare benefit related correspondence materials, including quick reference guides, enrollment guide, websites, and benefit information booklets to ensure appropriateness for the intended audience. • Conducts training for TRS health staff, participating and non-participating school districts, school district employees, and other agency staff. • Responds to appeal reviews regarding TRS- ActiveCare eligibility and enrollment issues and oversees vendor adjudication of benefit determination appeals, including those involving a determination of medical necessity. • Serves as a technical resource regarding TRS-ActiveCare benefit programs, rules, policies, procedures, processes and systems, including identifying and developing new and enhanced internal processes. • Works cross-divisionally with TRS Health Division to promote, enhance, and support operational strategic objectives on the TRS-ActiveCare Plans. • Assists with TRS-ActiveCare implementation projects and initiatives and may lead sub-team projects within an implementation plan. • May assist with identifying test cases and be involved in testing to ensure changes are implemented accurately. Research, Analysis and Reporting • Researches and analyzes other state group health programs for comparison with TRS health plans, claims data reports from vendors, and other TRS health plan data. • Researches, analyzes, resolves and responds to complex and/or time-consuming inquiries from school districts regarding ActiveCare plans, rules, policies, procedures, and systems. • Researches, analyzes, and evaluates current program plans, practices, policies, procedures, guidelines, processes, systems, and forms. • Reviews documentation relating to benefits to ensure conformity to agency and legal requirements. • Analyzes the impact of new and proposed legislation on TRS-ActiveCare programs and operations, and in developing recommendations for future legislation. • Prepares ad hoc and periodic reports for TRS leadership, Board of Trustees, Texas Department of Insurance, and Legislative Budget Board. • Assists with preparing reports to support trends, opportunities, issues, and discrepancies related to TRS-ActiveCare. Vendor and Contract Administration • Partners with and oversees the contracted third-party enrollment administrator to ensure accuracy of TRS-ActiveCare enrollments. • Coordinates program changes with vendors, school district personnel, and TRS staff. • Serves as Health contact for the enrollment, medical, and pharmacy vendors. • Maintains strong lines of communication with vendor field representatives engaged with districts and regions. • May participate in the vendor procurement process, including assisting with developing contract specifications and requests for proposal (RFP), selecting vendors, and drafting or modifying new and re-issued group health benefit contracts. • Performs related work as assigned. Required Education WHAT YOU WILL BRING: • Bachelor's degree from an accredited college or university in accounting, finance, mathematics, business, health care administration or similarly related field. • High school graduation or equivalent and additional full-time experience in health insurance administration, account management, customer success management, customer service-related position involving interpreting, applying, and communicating complex laws, regulations, and policies , or similarly related experience may substitute on an equivalent year-for-year basis. Required Experience • Four (4) years of full-time directly related, progressively responsible experience in customer success management, account management, health insurance administration, customer service-related position involving interpreting, applying, and communicating complex laws, regulations, and policies or related experience. • A master's degree or doctoral degree in a directly related field may be substituted on an equivalent year-for-year basis. Preferred Qualifications • Recent experience in the group health insurance industry. • Experience planning and facilitating meetings and or formally presenting in a group setting. • Bilingual in English and Spanish. Knowledge Of • Health insurance enrollment and eligibility guidelines, health benefit claims processing, Medicare, coordination of benefits, contracting requirements. • The operations and benefits of Medicare, Medicaid, TRICARE, and other universal Claim administration, utilization management, employee benefits, and general underwriting practices and principles government programs. • TRS laws, regulations, policies, procedures, processes, and systems. • TRS-ActiveCare Rules and Laws, Administrative Guide • Knowledge of health care regulatory and legislative process, healthcare market and products. • Basic understanding of district operation and healthcare financing • Basic understanding of health insurance plan operations and key benefit terms. Skills In • Reviewing documentation and in interpreting and applying complex laws, regulations, rules and policies, and in making decisions based on sound judgment. • Project management, and in planning, organizing, and prioritizing work assignments to manage a high- volume workload in a fast-paced and changing environment, and in completing detailed work with a high degree of accuracy. • Analyzing problems and devising effective solutions. • Clear and concise written, presentation, verbal and interpersonal communication skills in order to work across various departments with various levels of management handling sensitive or difficult situations as well as develop and deliver formal training to internal and external customers. • Capable of working independently and in group settings with ability to respond to rapidly changing priorities. • Flexible and responsive, capable of managing multiple projects concurrently. The use of personal computer and various software programs to include Microsoft Word, Excel, and Outlook. • Providing effective customer service and employer services. Ability To • Communicate adverse information to members regarding their plan benefits while educating about the value of the plan. • Establish and maintain pleasant relationships with TRS-ActiveCare participating employers and the ones joining TRS-ActiveCare. • Establish and maintain harmonious working relationships with co-workers, agency staff, vendors, contractors, and other external contacts. • Work effectively in a professional team environment. Military Occupational Specialty (MOS) Codes Veterans, Reservists or Guardsmen with experience in the Military Occupational Specialty ( https://www.trs.texas.gov/files/trs-military-crosswalk.xlsx ) along with the minimum qualifications listed above may meet the minimum requirements and are highly encouraged to apply. Please contact Talent Acquisition at careers@trs.texas.gov with questions or for additional information. To view all job vacancies, visit www.trs.texas.gov/careers or www.trs.csod.com/careersite . For more information, visit www.trs.texas.gov