Medical Policy Manager jobs in Brockton, MA

Job Description

The Senior Account Manager– Policy Services (SAM-UW/PS) acts as the administrative liaison between all internal and external contacts regarding the processing and servicing of workers’ compensation policies/certificates. The SAM-UW/PS takes a lead role in negotiating and resolving issues with members and/or brokers.

Essential Job Functions

Handle customer service inquiries incoming over the phone and by e-mail from members and broker/agents, processing of policy renewals, endorsements and audits, and filings with regulatory agencies. Ability to solve significant member/broker issues independently within authority.

Ability to handle difficult situations with brokers and members regarding adverse results from payroll audits, cancellations, and other issues related to the member agreements.

This position requires strict attention to detail, consistent and accurate documentation and timely and efficient execution of all assigned duties.

Classification

This is a full-time position, non-exempt under FLSA.

Interfaces

The SAM-UW/PS interfaces with internal and external resources as follows:

·       The SAM-UW/PS SAM-UW/PS interfaces with the Underwriting department in working to obtain the required documents to process and release new business policies.

·       The SAM-UW/PS SAM-UW/PS works with Accounting department staff on the processing of new business payments, existing member payments, refunds, cancellations & reinstatements.

·       The SAM-UW/PS SAM-UW/PS works with Claims department when there is a question regarding class codes, locations or divisions for a claimant, as well as with Claims Admin department for cancellations, reinstatements, and member phone calls.

·       The SAM-UW/PS SAM-UW/PS is a front-line service representative of Cove Risk with Members regarding all policy questions and concerns.

·       The SAM-UW/PS SAM-UW/PS interfaces with state regulators and payroll audit vendors regarding policy compliance, experience modifications and electronic reporting and payroll audits.

·       The SAM-UW/PS SAM-UW/PS interfaces with brokers/agents regarding policy related questions with their book of business.

·       The SAM-UW/PS SAM-UW/PS works closely with Marketing department regarding problems or concerns of outside brokers/agents.

·       The SAM-UW/PS works closely with Operations Supervisor regarding broker of record changes.

·       The SAM-UW/PS reports to the Operations Supervisor: Accounting & Policy Administration.

Responsibilities

·       Ensure that the book of business is up to date and accurate for all components of the workers compensation policy and maintained in accordance with the policies and procedures for each Group and the Administrator.

·       Work in connection with other Underwriting Assistants to achieve the goals and deadlines of the department

·       Assess workflows and processes and determine improvements and efficiencies

Functions

·       Processing and issuance of new business policies.

·       Ensuring that experience modification factors are up to date

·       Processing of endorsements, including all related correspondence and documentation.

·       Processing payroll audits – (common renewal on January 1).

·       Responding to written requests for loss runs, experience mod worksheets, audit worksheets in a timely manner

·       Reviewing member agreement terms, reservations of rights notice periods, handling potential default situations. Working with brokers and members to retain their membership in each respective entity, including educating members and brokers of the notice requirements. In cases where proper notice is not given working collaboratively to retain the member in the self-insured entity.

·       Communicating with brokers inquiring about umbrella policies and related issues. Working to provide brokers with the information needed to satisfy their other carriers about the self-insurance group. Discussing accounts receivable balances with member or broker for member, including pending cancels and cancelled accounts

·       Handling e-mails and phone calls from assigned accounts either from members or brokers on a daily basis.

·       Preparing for renewal cycle with regard to experience mods, payroll changes, discount changes

·       Communicating with Accounting Department on changes in banking information for EFT accounts, refunds overdue or credits on current term, pay-as-you-go accounts and other financial matters.

·       Keeping data and notes in system up to date at all times

·       Indexing scanned items, and other duties as assigned

·       Communicating concerns on existing policies regarding class codes, audit issues or other matters to Underwriting Manager for evaluation and review for renewal.

Qualifications

Minimum five years’ work experience handling workers compensation policies. Deep knowledge of workers compensation class codes, comfort level working with and researching in the Scopes manual, knowledge of the factors that drive the experience modification calculation. Comfort level explaining these matters to brokers and/or members on the phone and through e-mail as needed. Agency work experience preferred.

Work Environment

This position works in a professional office environment. This position routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, laser printers, and fax machines.

Language Skills

Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar. The ability to effectively communicate in the English language.

Privacy and Protected Information

Personal health information (PHI), also referred to as protected health information, generally refers to demographic information, medical history, test and laboratory results, insurance information and other data that a healthcare professional collects to identify an individual and determine appropriate care.

Protected Personal Information (PPI) under MA law is defined as a person’s first name and last name or first initial and last name in combination with any one or more of the following data elements that relate to such person: social security number; driver’s license or state-issued identification card number; or financial account number, or debit or credit card number (with or without any required security code, access code personal identification number or password) that would permit access to a person’s financial information.

For purposes of this Job Description both PHI and PPI will be referred to as Protected Information.

During the course of your employment you will come in contact with Protected Information relative to claimants, members and employees. Each employee will use extreme care to protect the confidentiality of Protected Information. Protected Information should be shared only with authorized contractors and vendors. Employees shall not access, transmit, disclose or in any way obtain Protected Information for non-business purposes. Employees should only access the minimum Protected Information necessary to successfully perform their duties. Non-electronic Protected Information will be secured at all times. Every effort should be made to minimize the printing of Protected Information. Once printed Protected Information must be quickly retrieved from the printer and secured. Printed Protected Information should not be treated casually. Printed Protected Information should be disposed of in the secured recycle bins or shredded. Protected Information should never be disposed of using unsecured means.