Managed Care Specialist - Unite Here Health

Job Brief and Employer Overview:

UNITE HERE HEALTH is an ERISA “employee welfare benefit plan” and a not- for-profit multi-employer Taft-Hartley trust fund that provides health and other benefits to members across the country.

The Managed Care Specialist role functions as the main point of contact between the operational departments of UHH and a wide range of managed care vendors and providers. This position works closely with internal departments to help identify and resolve issues, implement new benefit platforms, and overall guide the relationship between UHH and our service provider partners. The MCS supports UHH Leadership in holding vendors accountable for providing the highest level of services at the lowest cost to UHH and its members. The Managed Care Specialist will work towards becoming a subject matter expert on the vendor relationships they are responsible for overseeing.

Responsibilities:

• Builds relationships with contracted providers and managed care vendors to facilitate problem identification and resolution, set expectations and evaluates performance.
• Negotiates renewals with vendors and services providers and works to capture key initiatives in contracts.
• Thoroughly reviews and edits service provider contracts accordingly.
• Coordinates and ensures compliance with the Fund’s vendor monitoring policy.
• Works with vendors and staff to assist in implementation projects and other projects
• Designs and develops benefit and/or provider/managed care vendor analysis reports on a regular or ad hoc basis as directed by management
• Analyzes and drafts data and resolutions for Board of Trustees
• Contributes ideas to plans and achieving department goals
• Demonstrates the Fund’s Diversity and Inclusion (D&I) principles in their conduct at work and contributes to a safe inclusive culture with equitable opportunities for success and career growth
• Exemplifies the Fund’s BETTER Values in contributing to a respectful, trusting, and engaged culture of diversity and inclusion
• Performs other duties as assigned within the scope of responsibilities and requirements of the job
• Performs Essential Job Functions and Duties with or without reasonable accommodation

Qualifications and Background:

Must be Fully Vaccinated for COVID-19

Years of Experience and Knowledge

• 3 ~ 5 years of direct experience working in employee health benefits administration, provider relations or a related field
• Working knowledge and experience in analyzing healthcare plans and/or employee benefits
• Working knowledge and experience in health insurance, managed healthcare and medical claims processing

Education, Licenses, and Certifications

• Bachelor's degree in Business, Healthcare Administration, or related field, or equivalent work experience required

Skills and Abilities

• Intermediate level Microsoft Office skills (PowerPoint, Word, Outlook, Excel, Teams)
• 10% ~ 15% work-related travel
• Communication skills (written and verbal)
• Detailed-oriented and organization skills
• Strong analytical skills

Compensation/Benefits and Job Structure:

• This is a full-time, hybrid position located in Aurora, IL. The company offers competitive compensation and generous benefits. Unite Here Health maintains a culture of respect for all employees and commitment to including diverse voices and backgrounds at all levels of the organization.