At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.
Come join us and be part of a purpose driven company who is invested in your future!
Job Summary
This position is responsible for creating, managing and reporting processes designed to monitor and evaluate activities and functions delegated to contracted, delegated entities and vendors for assigned products and business lines according to all corporate and regulatory/accreditation requirements and standards. Ability to travel (up to 25%).
Required Job Qualifications:
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- Bachelor's degree in business or medical OR 4 or more years' experience in a managed care environment.
- 4 years in a leadership role that includes direct accountability and responsibility and direction of staff.
- 4 years' experience in directly performing delegated oversight activities.
- Must have experience auditing Medical, Dental, Vision, and Behavioral health claims in government plans.
- Experience in reviewing customer service and sales calls.
- Project Management skills and experience.
- Knowledge of regulatory/accreditation requirements and standards (TDI, NCQA, URAC).
- Verbal and written communication skills.
- Organizational skills and the ability to handle multiple priorities.
- PC proficiency to include Word, Excel, PowerPoint and Lotus Notes.
Preferred Job Qualifications:
- Bachelor's degree in business or medical.
- Knowledge of Power Point, Visio and Access.
- College level courses or certification in project management.
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
HCSC Employment Statement:
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.