Health Management Analyst (Night Shift)

Cobden & Carter International


Date: 5 days ago
City: Taguig
Contract type: Full time
  • Manage Non-Quantitative Treatment Limits (NQTL) portion of parity assessment, including:
  • Attend internal and off meetings with QTL/NQTL team.
  • Prepare NQTL carrier data requests on behalf of each client:
  • Review member facing vendor documents such as summary plan designs, summary of benefits, etc.
  • Monitor carrier and vendor responses to data requests.
  • Prepare initial review of carrier responses for parity projects.
  • Determine the appropriate results and recommendations necessary for parity concerns and findings for various NQTLs and collaborate with MHPAEA Technical Reviewer to determine accuracy of language used.
  • Coordinate with project manager regarding sending requests, timing, status, and follow-up.
  • Validate completeness of response and report any issues or impact to timeline proactively to project manager.
  • Map carrier responses to appropriate section of NQTL document
  • Collaborate with health management senior reviewer and project manager to conduct follow up calls/emails with carriers/vendors as needed for clarification and submission of additional documents.
  • Support the overall completion of the NQTL component of the report.
  • Schedule meetings and coordinate efforts of colleagues
  • Participation in weekly or bi-weekly project status calls as needed.
  • Participate in MHPAEA roundtable as needed.
  • Maintain materials/documentation in a manner consistent with work processes and peer review standards (e.g., filing of drafts, deliverables, client, and carrier documentation)


Qualifications:

  • 3+ years of working experience dealing with US health and welfare plans, ideally gained in a benefit consulting/brokerage firm, Health Plan, Third Party Administrator, Regulatory Agency, Legal/Compliance Firm, or insurance company. Prior experience working with US based consulting or health care firm a plus.
  • Understanding of US health plan utilization/case management processes, network management, credentialing, quality management, pharmacy prior-authorization processes and health plan operations
  • Basic understanding of Mental Health Parity regulations
  • Intermediate knowledge and experience in MS Office particularly in Microsoft Excel and PowerPoint
  • Excellent oral and written communication skills in English
  • Strong communication and collaboration skills:
  • Client service orientation and ability to respond to all communications effectively and in a timely manner.
  • Ability to ask the right questions and seek help where appropriate from colleagues and clients.
  • Ability to collaborate and work across all levels of the organization, work in teams, leverage the resources of other related groups to accomplish common objectives, and work on virtual teams across geographies.

How to apply

To apply for this job you need to authorize on our website. If you don't have an account yet, please register.

Post a resume

Similar jobs

Financial Service Representative (Asset Movement)

Wells Fargo, Taguig
2 days ago
About This RoleWells Fargo is seeking a Securities Operations Representative for Asset Movement (Wealth and Investment Management)In This Role, You WillPerform various operational tasks on complex securities that require general knowledge of unit functions and systemsSupport securities operationsIdentify ways to improve the overall processPerform moderately complex duties such as processing, researching inquires and reconciling transactionsReview time sensitive documentsReceive direction from...

Omni Relationship Manager

Nasdaq eVestment, Taguig
2 days ago
Why NasdaqWhen you work at Nasdaq, you’re working for more open and transparent markets so that more people can access opportunities. Connections can be made, jobs can be created, and communities can thrive. We want all our employees to have access to opportunity, too. That means planning for career growth, ensuring you have the tools you need, and promoting an...

Store Manager

Tesla, Taguig
6 days ago
What To ExpectAs a Store Manager at Tesla you are a seasoned and charismatic retail leader, responsible for overseeing and driving sales and delivery operations at your location. In this role, you will be responsible for leading the overall management and sales execution, recruitment, training, and development of a dynamic store team. Your team will look to you to set...