Health Care Vendor Administrator

Company: STRS Ohio
Location: Columbus
Posted on: October 18, 2024

Job Description:

STRS Ohio, STRS The State Teachers Retirement System of Ohio (STRS Ohio) is seeking a Health Care Vendor Administrator to join its Health Care Services Department.Established in 1920 and serving Ohio's educators, STRS Ohio is one of the nation's premier retirement systems, serving over 500,000 active, inactive, and retired public-school teachers, and university faculty members, managing approximately $95.3 billion as of June 30, 2024, in assets and paying more than $7 billion in benefits annually.STRS Ohio provides a competitive pay, and a comprehensive benefits package including on-site parking, educational assistance, subsidized medical insurance, fully paid dental and life insurance, vacation and sick leave, retirement benefits and on-site fitness center. At STRS Ohio, you can experience rewarding work in a professional, business casual work environment. We welcome, celebrate, and promote respect for everyone. We are continually seeking bright and talented individuals to join our team.Compensation:$85,200-$93,720Work Schedule:8:00am-5:00pm Monday through Friday, with up to two days per week remote work opportunities.General Summary:Under the direction of the assistant director, Program Administration and Strategic Development, actively manage, lead and coordinate activities with health care services vendors and internal department operations to enhance effectiveness of the health care services program for State Teachers Retirement System of Ohio (STRS Ohio).Summary of Responsibilities:

• Assume primary responsibility for effective administration, service performance, account management, performance warranties, open enrollment activities, issue resolution and foster integrated participant communications between STRS Ohio and vendors.
• Assume primary responsibility for overseeing drafting, development, review, and evaluation of Requests for Proposals (RFPs) for plan administration services. Manage RFP initiatives for deadline management, issue identification, internal staff review, and candidate response/accountability to monitor/track the projects to completion.
• Manage health care plan administration contracting initiatives for medical, dental, vision, pharmacy, disease management long-term care and data warehousing programs by overseeing drafting, business review, leadership review, iteration management and coordination of legal counsel reviews for contract negotiations and agreement finalization.
• Manage oversight of exiting vendor performance measurement and accountability for contracted standards that includes examining, analyzing and reporting on vendor performance against contractual guarantees and internally established performance metrics; ascertaining and facilitating payment of performance penalties due from vendors; communicating with vendors when their performance falls short of expectations or on agreed upon contract provisions and/or performance guarantees.
• Oversee and coordinate implementation projects and "on-boarding" of new vendors, for all meetings, operational activities, cultural training and serve as liaison for financial and technical matters.
• Work directly with vendors to ensure completion of benefit design templates for the upcoming year by reviewing Certificates of Coverage, open enrollment materials and applicable reference files for each health benefit program vendor to ensure they accurately reflect STRS Ohio eligibility and vendor benefit changes. Coordinate procurement and receipt of health benefit vendors' plan material, reports, contracts, records and data.
• Identify and communicate vendors' key dates and processes to ensure open enrollment timeframes are met with all vendors.
• Manage and respond to escalated vendor administrative plan enrollee issues and refer issues that cannot be resolved at this level to the assistant director, Program Administration and Strategic Development or director, Health Care Services.
• Work in partnership in the review and editing of current and creation of new; health care program materials by working collaboratively with team members.The above list of duties is intended to describe the general nature and level of work performed by persons assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the persons so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct and control the work of associates under supervision.Summary of Qualifications:
  • Bachelor's degree in relevant field required.
  • Graduate course work and/or Certified Employee Benefit Specialist (CEBS) certification preferred.
  • Five years relevant health care experience required.
  • Thorough knowledge of the health care industry for Medicare rules, ACA, benefits administration, legal contracts, care/disease management, HIPAA and COBRA required.
  • Knowledge of general principles of group health and welfare programs including Medicare, managed care, claims administration experience, funding, contracts, group underwriting, pricing and risk management preferred.
  • complex issues, design new innovative ideas and implement complicated solutions.

Keywords: STRS Ohio, East Lake , Health Care Vendor Administrator, Healthcare , Columbus, Florida