Employer Services Specialist Ii

• Research and Resolution of Employer, Broker and Consultant Initiated Issues: Formulate solutions to complex and sensitive employer, consultant, broker-initiated concerns, using considerable discretion and independent judgment. Investigate circumstances surrounding purchaser issues and evaluating various courses of conduct. Negotiate reasonable and contractually defensible resolution of purchaser issues by weighing conflicting information (regulations, legal principles, and regional goals), departing from prescribed standards and binding KP. Troubleshoots emerging issues, summarizes information, and works with relevant stakeholders to provide the leadership team with the information needed to make sound decisions.
• Issue Entry and Documentation: Log issues received and maintain updated status of resolution in the system of record. Ensure accurate and complete data is entered into the correct business applications.
• Knowledge and Professional Development: Complete required training around health plan products and processes. Stay current on applicable laws and regulations. Pursue opportunities to continuously develop skills. Demonstrates ability to collaborate with management to support team member training and development opportunities.
• Process Improvement and Data Analysis: Identify, analyze, and report trends and/or systematic issues as they become apparent. Collaborates with internal stakeholders to effectively meet the needs of external consumers (members, groups, consultants, brokers). Provide consultation and recommendations to management around process improvement opportunities & solutions. With limited guidance coordinates the collection and validation of business requirements for process improvement initiatives.
• Retention and Growth Opportunities: Identify growth and benefit expansion solutions to better meet purchaser health care needs. Report trends around issues groups are experiencing to the account management team to inform strategic account engagement and renewal planning. Positions the organization to ensure optimal membership growth, and to meet retention targets.

• Minimum of six (6) years in a health care, health insurance, or sales and marketing environment.

• Bachelors degree OR four (4) years of directly related experienced required.

N/A

• Ability to analyze quantitative and qualitative data.
• Ability to coordinate multiple components of care.
• Ability to analyze processes, identify root cause and implement process improvements.
• Demonstrated understanding of current / future trends and changes in healthcare / health insurance laws / regulations.
• Ability to apply judgment and make autonomous decisions to quickly resolve issues on behalf of client.
• Demonstrated ability to execute multi-disciplinary issues to closure with moderate direction.
• Strong customer service focus.
• Demonstrated ability to deliver recommendations and presentations to management.
• Knowledge of health plan information system technologies including but not limited to: Claims, Membership, Care Delivery, Sales Force, Customer Relationship Management, Case Management.
• Proficiency in computer and analytic skills.
• Background experience in brokerage/consultant, insurance carrier, TPA, or benefits administration.
• Demonstrated understanding of competitors strengths, weaknesses and strategies.
• Demonstrated expertise in dealing with difficult situations.
• Ability to communicate effectively and courteously with customers.
• Strong knowledge and experience in using multiple client databases & system.
• Effective written and verbal communication skills.
• Demonstrated strong organizational skills, problem solving, interpersonal skills, independence and initiative.
• Dedicated to helping members and customers.

• Previous member/patient navigator or care coordination experience.
• Familiarity with medical terminology, benefit interpretation, authorization/precertification of service, and provider network experience.
• Proficient in conducting root cause analysis and service recovery.
• Ability to explain the KP value prop during conversations with members.
• Six (6) years of healthcare group/broker consulting.
• Medical office operations, Appointment Contact Center, or Member Service Contact Center experience or exposure.
• Provider network experience.

PrimaryLocation : California,Rancho Cucamonga,Empire Corporate Plaza
HoursPerWeek : 40
Shift : Day
Workdays : Mon, Tue, Wed, Thu, Fri
WorkingHoursStart : 08:00 AM
WorkingHoursEnd : 05:00 PM
Job Schedule : Full-time
Job Type : Standard
Employee Status : Regular
Employee Group/Union Affiliation : NUE-PO-01|NUE|Non Union Employee
Job Level : Individual Contributor
Job Category : Insurance & Claims
Department : Po/Ho Corp - Grp Reltn-Individual Plans - 0315
Travel : Yes, 10 % of the Time
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.