Teacher Retirement System of Texas · 3 hours ago
Health Plan Program Manager
Austin, TX
Full-time
Hybrid
Senior Level
5+ years expTeacher Retirement System of Texas is dedicated to designing high-quality healthcare for Texas public educators. They are seeking an experienced Health Plan Program Manager to conduct research and analysis, manage vendor relationships, and oversee procurement and contracting processes to optimize health plan performance.
Government Administration
Hiring Manager
Melinda Ellinger
Responsibilities
Conducts in-depth research and analysis of health care data to evaluate plan performance, identify trends, and develop actionable insights
Synthesizes data into clear and concise analyses to inform decision-making and drive improvements
Utilizes data visualization tools and techniques to effectively present complex data to diverse audiences
Develops and automates SQL queries in our internal data warehouse to extract claim data for use in analyses and dashboards
Reviews reporting of health care data from external sources including from TRS' health care consultants, insurance companies, or other industry resources
Analyzes provider reimbursement levels, high-cost claims, costs by geographic area and place of service, and claim accuracy
Identifies enrollment and cost trends, cost-saving opportunities, and potential fraud, waste, and abuse
Analyzes claim data to support invoice processing
Conducts regular assessments of vendor activities to evaluate performance based on good understanding of contracts and adherence to contractual obligations
Reviews and validates vendor reports on health plan performance
Reconciles financial guarantees relating to medical loss ratios, claim trends, pharmacy rebates and discounts, and ROIs
Directs the work of vendors and monitors their progress on enacting TRS initiatives and information requests
Addresses and resolves non-compliance or subpar performance issues with vendors and escalates issues appropriately
Leads meetings with vendors and manage agenda items
Conducts market research to assess the products, services, and viability of companies that could potentially enhance TRS’ services
Collaborates with internal stakeholders within the Health, Purchasing, and Legal & Compliance divisions, as well as with consultants to develop technical requirements, scopes of work, evaluation criteria, and procurement documents
Acts as project manager to ensure procurement documents are produced timely and according to project workplans
Negotiates contract renewal terms, requirements, and improvements
Evaluates proposals from vendors and make recommendations
Communicates with stakeholders related to plan performance and initiatives, claims and utilization, provider network updates, pharmaceutical changes, marketplace situations and trends
Recommends and implements strategies to optimize benefit delivery, plan performance, cost containment, and clinical outcomes
Collaborates with internal and external auditors to conduct claim and vendor performance audits; track all audit findings through resolution
Reviews legislative bills impacting the health plan and provide fiscal note analyses. Implement bills that become law
Qualification
Required
Bachelor's degree from an accredited college or university in health information management, health care administration, public health, statistics, finance, business or a closely related field
High school diploma or equivalent and additional full-time experience in health plan administration, health data and/or health financial analysis, claim auditing or similarly related experience may be substituted on an equivalent year-for-year basis
Five (5) years of full-time directly related, progressively responsible experience in administration of a health insurance plan, health insurance consulting, claim auditing, or similarly related experience
Experience in analyzing and visualizing health care claims data
A master's degree or doctoral degree in a directly related field may be substituted on an equivalent year-for-year basis
Company
Teacher Retirement System of Texas
The Teacher Retirement System of Texas (TRS) is responsible for investing funds under its stewardship and for delivering benefits to members as authorized by the Texas Legislature.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Don Green
Chief Financial Officer
Janie Duarte
Deputy Chief Financial Officer
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