Plan Design Specialist jobs in Los Angeles, CA
Plan Design Specialist works closely with clients to design group health, dental and/or life insurance plans to create an overall benefit package. Works alongside underwriters, but is not an underwriter role. Being a Plan Design Specialist monitors and analyzes cost trends. May handle more complex plan design. Additionally, Plan Design Specialist requires a bachelor's degree or its equivalent. Typically reports to a supervisor or manager. The Plan Design Specialist gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Plan Design Specialist typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
Recently Added Plan Design Specialist jobs
Health Plan Specialist (FT)
- Los Angeles Jewish Health
-
Los Angeles, CA
FULL_TIME
-
We value our employees! We offer long term employment opportunities with job stability, including supporting and encouraging career growth advancement. We offer Health, Dental and Vision insurance, Paid Time Off, 9 Paid Holidays, 403(b) with Matching Retirement Plan, Life insurance (paid by the company) and a team spirit workplace culture!Candidates should be aware that Los Angeles Jewish Health (LAJH) currently maintains a policy requiring employees to be fully vaccinated. New LAJH employees should be fully vaccinated (i.e., two weeks after last dose) by their start date. LAJH is an equal opportunity employer, and will provide reasonable accommodation to those unable to be vaccinated where it is not an undue hardship to the company to do so as provided under federal, state, and local law.Administrative Functions:
- Serve as a point person to assist vendor with the completion of health plan management set up and maintenance by providing:
- a. Copies of participant’s demographic and entitlement information.
- b. Copies of provider contracts and current Medicare Part D bid.
- c. Accounts payable and accounts receivable beginning balances and detail.
- d. Chart of accounts.
- e. Current IBNR detail including any outstanding inpatient claims.
- Maintain access to health plan management vendor system to generate reports and review data status.
- Ensure all administrative invoices into Oracle, research and respond to phone call, email and fax inquiries regarding invoice receipt and payment
- Submit enrollment and disenrollment information to health plan management vendor and DHCS, as requested.
- Verify proper Centers for Medicare and Medicaid (CMS) capitation rates via CMS’ rate book.
- Review Monthly Membership Report (MMR) generated by health plan management vendor in excel format.
- Provide claims to health plan management vendor for processing.
- Prepare manual checks for Executive Director’s signature.
- Communicate with health plan management vendor to assure accurate payment and provide updated provider contract as needed.
- Review weekly report of authorized and unauthorized claims.
- Clear SOC monthly with DHCS.
- Record 820 DHCS payment detail on payment spreadsheet monthly.
- Collaborate with health plan management vendor to determine each permanently-place SNF participant’s share of cost and make proper deductions from monthly nursing home bills.
- Review monthly general entry generated by health plan vendor per the financial close calendar.
- Enter service authorizations and/or support electronic service authorization imports to health plan management vendor based on file specifications.
- Review monthly IBNR and accounts payable aging reports.
- Provide in-center encounters to health plan vendor for quarterly risk adjustment data submission to CMS.
- Review immediate correction of errors in risk adjustment data.
- Review semi-annual Risk Adjustment Data reports provided by health plan management vendor to identify variances.
- Support relevant regulatory reporting.
- Participate in monthly client teleconferences with health plan management vendor and key LAJH staff.
- Stay current on CMS’ data reporting requirements via the Health Plan Management System (HPMS), NPA conference calls and CMS communication.
- Research and take necessary action to resolve Medi-Cal eligibility issues.
- Review Capstone audits and schedule meetings with providers.
- Research and resolve errors on RAPS return files.
- Research statements received by participant to make sure providers have the correct insurance information in order to process claims for payment.
- Understands fiscal issues and is appropriately involved in meeting budget targets.
- Consistently meets or exceeds BCSC target for productivity.
- Continually seeks better ways for delivering services and communication.
- Consistently meets or exceeds BCSC customer services targets.
- Demonstrates respect for and promotes participant right including dignity, self-determination, access to care, confidentiality and independence.
- Effectively collaborates with staff peers and contractors to meet BCSC goals and further success.
- Complies with all policy and procedures of BCSC.
- And other duties as assigned.
Education and Experience:- Degrees and diplomas: High school diploma required. Bachelor’s degree preferred.
- Certificates, licenses: Must have a valid California driver’s license. TB screening and successful completion of a health examination by a health care provider is required for employment.
- Experience: Qualified professional in the field of health plan claims management with demonstrated or potential competence in working with health plan management functions. Five years of experience with at least 2 years supervisory experience. Knowledgeable about senior health care and PACE.
- Skills/Aptitudes: Ability to provide care for the frail elderly. Ability to work independently and to lead a interdisciplinary Team. Good organizational and supervisory skills. Ability to handle complex interpersonal situations.
- 18 Days Ago
Health Plan Specialist
- Los Angeles Jewish Health
-
Los Angeles, CA
FULL_TIME
- We value our employees! We offer long term employment opportunities with job stability, including supporting and encouraging career growth advancement. We offer Health, Dental and Vision insurance, Pa...
- 12 Days Ago
Claims Specialist
- Ardmore Home Design
-
Industry, CA
FULL_TIME
- About the Company Ardmore Home Design (AHD), founded in 2008, is a privately-owned manufacturer and wholesaler of luxury home décor headquartered in eastern Los Angeles County. We operate under the fo...
- 29 Days Ago
Admissions Operations Specialist
- ArtCenter College of Design
-
Pasadena, CA
FULL_TIME
- ArtCenter College of Design is searching for an experienced Admissions Operations Specialist to join our team. The salary range for this position: $23.07 - 24.72 per hour. ArtCenter has a 35 hour work...
- Just Posted
Technical Services Specialist
- ArtCenter College of Design
-
Pasadena, CA
FULL_TIME
- ArtCenter College of Design is searching for an experienced Technical Services Specialist to join our team. The salary range for this position: $24.72 - 28.29 (35 hours per week)Final salary is based ...
- 1 Month Ago
Design Specialist
- US Rock Corporation
-
Inglewood, CA
FULL_TIME
- Description The landscape design specialist is the key point of contact for US Rock Corporation’s Design Services. The use of creativity, beauty in nature, and inherent design ability to create harmon...
- 1 Month Ago
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0 Plan Design Specialist jobs found in Los Angeles, CA area
Template Design Specialist
- JBCPlatform
-
Los Angeles, CA
- Job Description Job Description Title: Template Design Specialist Company Description: Healthcare Location: Los Angeles,...
- 4/26/2024 12:00:00 AM
Environmental Graphic Designer
- 24 Seven Talent
-
Costa Mesa, CA
- Our client, a rapidly growing global restaurant, is looking for a Graphic Designer - Environmental Design Specialist to ...
- 4/26/2024 12:00:00 AM
INSTRUCTIONAL DESIGN SPECIALIST
- Solugenix Corp
-
Irvine, CA
- Instructional Design Specialist Irvine, CA (Remote) 6-Month Contract Solugenix is assisting a client, a prestigious and ...
- 4/24/2024 12:00:00 AM
Architect, Architectural Project Manager
- Urban Design Specialists LLC
-
Los Angeles, CA
- Job Description Job Description Urban Desing Specialists is looking for an Architectural project manager to join our tea...
- 4/23/2024 12:00:00 AM
Front Desk
- Urban Design Specialists LLC
-
Los Angeles, CA
- Job Description Job Description Pilates Studio Front Desk Position Are you a welcoming and organized individual with a p...
- 4/23/2024 12:00:00 AM
SOCIAL MEDIA AND GRAPHIC DESIGN MANAGER
- DeToledo High School
-
Los Angeles, CA
- Job Description Job Description Under the supervision of the Director of Strategic Communications & Marketing, this posi...
- 4/23/2024 12:00:00 AM
Sign Production Specialist/Graphic Designer
- FastSigns
-
Duarte, CA
- FASTSIGNS #69904 is hiring for a full-time Sign Production Specialist to join our team! Benefits/Perks: Competitive Pay ...
- 4/23/2024 12:00:00 AM
MicroStation CAD Designer
- MARRS Services, Inc.
-
Fullerton, CA
- Job Description Job Description Join our innovative team as we embark on exciting projects in the transportation sector....
- 4/22/2024 12:00:00 AM
About Los Angeles, California
Los Angeles (/lɔːs ˈændʒələs/ (listen);[a] Spanish: Los Ángeles), officially the City of Los Angeles and often known by its initials L.A., is the most populous city in California, the second most populous city in the United States, after New York City, and the third most populous city in North America. With an estimated population of four million, Los Angeles is the cultural, financial, and commercial center of Southern California. The city is known for its Mediterranean climate, ethnic diversity, Hollywood and the entertainment industry, and its sprawling metropolis. Los Angeles is the larges...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Plan Design Specialist jobs
$82,479 to $111,788
Los Angeles, California area prices
were up 3.2% from a year ago
were up 3.2% from a year ago
What does a Plan Design Specialist do?
Plan Design Specialist in Birmingham, AL
SmithGroup creates exceptional design solutions for healthcare, science and technology organizations, higher education and cultural institutions, urban environments, diverse workplaces, mixed-use and waterfront developments, and parks and open spaces.
December 13, 2019