Summary of Position * Lead the technical implementations for the ASO, Shared Administration and Network Access Programs with Third Party
Administrators (TPAs) as required.
* Manage the maintenance and enhancement of ASO including Shared Admin and Network Access product offerings.
* Collaborate with marketing teams to develop materials and tools that support sales and education efforts.
* Collaborate with internal stakeholders to resolve issues related to the needs of the ASO, Shared Administration and Network
Access programs.
* Provide input on benefit design changes and assist in documenting updates to ensure clarity and consistency for ASO, Shared
Admin and Network Access clients.
* Partner with Sales/Account management teams by providing expertise of technical documentation, ASO, Shared
Administration and Network Access product and process.
* Research market trends, competitor products, and regulatory changes to provide insight and support product updates and
improvements. Principal Accountabilities * Manage operational processes specific to ASO, Shared Admin, Network Access and Large Group segments.
* Work with IT and operations teams to ensure systems are configured correctly for ASO, Shared admin, Network Access
and Large Group segments including eligibility, billing, and reporting functions.
* Manage the implementation and the technical specifications of ASO , Shared Administration and Network Access.
Monitor any implementation updates related to ASO compliance, including ERISA, ACA, and HIPPA regulations.
* Assist in analyzing market trends, client feedback, and competitor offerings to identify opportunities for
enhancements.
* Contribute to the development of strategies for improvement and growth of ASO product offerings.
* Serve as the business SME to internal & external constituents on the ASO, Shared Administration and Network Access
programs.
* Develop and maintain cross-functional relationships. Engage the appropriate business/operations areas to research
issues identified for ASO, Shared Administration and Network Access programs. Assist in resolving escalated client
issues related to operational or benefit design challenges.
* Manage and respond to large group ASO client questions, offering detailed explanation of plan structures and
operational processes.
* Lead internal/external conference calls: planning, follow up, meeting scheduling, documentation preparation and call
notes distribution.
* Manage Sales/Account management teams by providing explanation of the ASO, shared Administration and Network
Access programs workflows.
* Collaborate with project leads on various projects/product initiatives related to our ASO programs.
* Review and prepare ASO-specific reports, such as funding performance, admin cost summaries and others.
Education, Training, Licenses, Certifications * Bachelor's Degree. Relevant Work Experience, Knowledge, Skills, and Abilities * 4 - 6+ years of relevant, professional work experience. (R)
* Extensive knowledge of ASO products, funding arrangements, and related services. (R)
* Strong understanding of health care regulations (ERISA, ACA etc.) and compliance requirements. (R)
* Familiarity with health plan pricing, claims administration and benefit designs. (R)
* Experience in claims and EDI transactions (837, 835, etc.). (R)
* Additional experience/specialized training may be considered in lieu of educational requirements. (R)
* Self-starter: ability to work on issues without being prompted and seeing issues through to completion. (R)
* Detail oriented; analytical and problem identification and resolution skills. (R)
* Strong data analysis skills; ability to discern patterns and trends. (R)
* Excellent collaboration skills and the ability to influence management decisions. (R)
* Excellent communication skills (verbal, written, presentation, interpersonal) with all types/levels of audience. (R)
* Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.). (R)
* Knowledge of/proficiency with applicable systems and platforms (FACETS, TruProvider and Salesforce). (R)
* Exceptional organizational and project management abilities to handle multiple priorities. (P) Additional Information
- Requisition ID: 1000002348
- Hiring Range: $63,000-$110,000
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EmblemHealth
Apr 09, 2025 