Director, TPA & Dental Service Operations Job Listing at Medical Mutual in Brooklyn, OH (Job ID 2500117)

Description

Note: This role requires three days per week in-office in Brooklyn, OH with additional in-office presence as needed.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Responsible for managing and coordinating various operational functions and systems, including claims processing, customer care, membership management, benefits administration, provider relations, appeals handling, front-end processing, disbursements, auditing, reporting, learning and development, and installations and implementations. This position ensures smooth and efficient operations to achieve customer satisfaction by overseeing all activities related to the third-party administration of self-funded medical, dental, and specialty benefits. Additionally, the Director contributes technical expertise to support the development, implementation, and maintenance of multiple efficient and effective Third-Party Administrator (TPA) systems.

Responsibilities

·         Directs the implementation, development, and maintenance of multiple TPA operations and customer inquiry systems. Ensures that all operational activities are processed and managed consistently and systematically, meeting or exceeding service levels, performance guarantees, and regulatory, corporate, and divisional objectives. Provides oversight of corporate audit and reporting teams supporting all Medical Mutual lines of business and subsidiaries, managing third[1]party audit facilitation, statistical analysis, audits, and data reporting to uphold corporate service levels and performance group benchmarks.

·         Serves as a dedicated advocate for continuous improvement, regularly evaluating processes, procedures, and platform configurations to minimize manual efforts, reduce costs, and enhance team productivity. Provides essential technical problem resolution to both internal and external business partners. Facilitates the communication of customer trends to executive leadership to foster strategic planning and expeditious problem resolutions.

·         Participates in and coordinates pre- and post-account client and vendor installations, implementations, and transition activities to ensure the company can effectively service contracts and achieve customer satisfaction.

·         Designs programs or products tailored to meet emerging benefit structures and evaluates both qualitative and quantitative results. Reviews services to ensure the administration process remains efficient and effective.

·         Develops and oversees the budget aligned with the annual operating plan, continuously analyzing and assessing resource requirements and engaging in strategic planning.

·         Mentors, empowers, and inspires staff, focusing on nurturing emerging leaders to support effective succession planning.

·         Performs other duties as required.

Qualifications

·         Bachelor's degree in business administration or related field.

·         Equivalent education and experience directly related to the role may substitute for a degree.

·         8 years progressive experience in health insurance operations or related field, 5 years of which are in a managerial capacity.

·         Demonstrated expert knowledge of all facets of Third-Party Administration medical, dental and specialty benefits, claims procedures, terminology, payment analysis and processing systems.

·         Strong analytical and problem-solving skills.

·         Strong interpersonal skills with the ability to communicate and present to all levels of management.

·         Intermediate to advanced Microsoft Office skills.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation:

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance — insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We're not just one of the largest health insurance companies based in Ohio, we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.