Health Claims Relationship Manager

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Job description

Health Claims Relationship Manager

Primary Duties & Responsibilities

At Globe Life, we are committed to empowering our employees with the support and opportunities they need to succeed at every stage of their career. Our thriving and dynamic community offers ample room for professional development, increased earning potential, and a secure work environment.

We take pride in fostering a caring and innovative culture that enables us to collectively grow and overcome challenges in a connected, collaborative, and mutually respectful environment that calls us to help Make Tomorrow Better.

Role Overview:

Could you be our next Health Claims Third Party Relationship Manager? Globe Life is looking for a Health Claims Third Party Relationship Manager to join the team!

In this role, you will be responsible for working with Third-Party Administrators (TPAs), internal staff and home office personnel to oversee delivery of a superior claims experience for all Globe Life Group Benefit product lines that meet Globe's processing, regulatory and oversight requirements. Dependent on workload, the position may support other health claim TPA relationships and group support for Globe Life.

Requires subject matter expertise in the field of group life and health claim processing and appeals (including some technical support, claims examination, and product management). This position will assist with responding to regulatory inquiries and will work closely with other business partners to implement standardized business processes for all of Globe Life's health insurance lines.

This is a Hybrid Role-Work remotely on Monday and Friday and In office Tuesday- Thursday.

What You Will Do:

• Update or develop claim guidelines and processes that are aligned with company standards, and communicate effectively to TPAs, including providing written directives regarding claims payment policies, and updating and maintaining Claim Manuals.

• Set clear expectations and create accountability to ensure service level and quality standards are being consistently met or exceeded, including monitoring service level reporting from administrators to ensure contractual standards, statutory prompt payment guidelines, and customer service metrics are being met; and working with TPAs to implement corrective action processes when necessary.

• Manage GLGB claims mailbox; route inquiries to appropriate stakeholders for handling; follow up to be sure issues are resolved.

• Work with administrators to ensure general practices, policies and procedures (e.g., application of Grace Period standards, privacy policies, etc.) are being applied consistently across GLGB business.

• Collaborate with TPAs on complex claim determinations and communications.

• Oversee customer complaints to ensure complaints and appeals are being resolved fairly and timely, and that decisions are communicated in clear, easy-to-understand language.

• Review of 2nd appeal letters prior to release by administrators; and working with legal and compliance to investigate and respond to customer complaints and regulatory inquiries, including No Surprises Act disputes.

• Manage High Dollar Claim review process.

• Develop and manage claim flyers, claim forms, claim letter libraries and privacy forms.

• Conduct periodic reviews of EOBs to confirm claims are being paid correctly, and that denials are using clear and appropriate denial codes.

• Participate with Internal Audit team in annual claim audit processes. Oversee external audit firms through semi-annual claim audit processes, communicate findings to TPAs and work through corrective action plans.

What You Can Bring:

• Bachelor's Degree in a related field.

• Minimum of 5 -7 years LA&H (Life, Accident and Health) claims experience.

• Strong written and verbal communication skills with focus on audience required.

• Ability to manage projects or processes with limited oversight from manager a must.

• Exceptional analytical/problem solving and organizational skills a must.

• Previous experience working with Third Party Administrators a plus.

• Experience understanding and interpreting contractual language in group supplemental and voluntary life and health policies (hospital/limited indemnity, supplemental medical expense, accident, critical illness/cancer, short term disability, group term life, etc.) Must have strong working knowledge of medical billing codes and terminology.

• Understands advantages and challenges of working with Third-Party administrators.

• Ability to listen, understand and document; investigate and analyze; and develop, propose, and obtain approval of solutions that satisfy the needs of all stakeholders.

• Team Leadership/Coaching Skills (primarily with external stakeholders).

• Demonstrates the ability to influence others to accept practices and approaches, and ability to communicate with senior executives within Globe, GLGB and our TPAs.

• Demonstrates creative, broad-based thinking; problem solving; systemic process evaluation and improvement.

• Strong problem-solving skills with ability to use combination of analysis, experience and judgment to develop feasible solutions; willingness to understand and enforce procedural standards.

• Well organized and efficient; detail oriented; proficient at documentation.

• Excellent time and change management skills.

• Must take ownership of tasks, projects, and relationships, and follow through on obligations.

• Demonstrates analytical and data interpretation skills.

• Confidence to make autonomous decisions with minimal supervision and seek input when appropriate.

• Strong knowledge of Microsoft Office Suite (Outlook, Word, Excel, Teams, etc.). Includes effective management of Outlook email and calendar; advanced use of Word to create process documents and fillable forms; use of Excel to understand and model data; and use of Teams to share and communicate with colleagues.

• Familiarity with Salesforce and Tableau is a plus.

• Values, supports and exemplifies GLGB cultural values of teamwork, trust, gratitude and respect.

Applicable To All Employees of Globe Life Family of Companies:

• Reliable and predictable attendance of your assigned shift.

• Ability to work full time and/or part time based on the position specifications.

How Globe Life Will Support You:

Looking to continue your career in an environment that values your contribution and invests in your growth? We've curated a benefits package that helps to ensure that you don't just work, but thrive at Globe Life:

• Competitive compensation designed to reflect your expertise and contribution.

• Comprehensive health, dental, and vision insurance plans because we believe that taking care of your well-being is fundamental to your performance.

• Robust life insurance benefits and retirement plans, including company-matched 401k and pension plan.

• Wellness club reimbursements and gym discounts to help you stay on top of your health.

• Paid holidays and time off to support a healthy work-life balance.

• Development training programs to enhance your skills and career progression and unlock your full potential.

Opportunity awaits! Invest in your professional legacy, realize your path, and see the direct impact you can make in a workplace that celebrates and harnesses your unique talents and perspectives to their fullest potential.

At Globe Life, your voice matters.

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