Company Statement
EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com.
Program Specialist, ASO Programs
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.
Qualifications:
- Bachelor’s Degree.
- 4 – 6+ years of relevant, professional work experience required
- Extensive knowledge of ASO products, funding arrangements, and related services required
- Strong understanding of health care regulations (ERISA, ACA etc.) and compliance requirements required
- Familiarity with health plan pricing, claims administration and benefit designs required
- Experience in claims and EDI transactions (837, 835, etc.) required
- Additional experience/specialized training may be considered in lieu of educational requirements required
- Self-starter: ability to work on issues without being prompted and seeing issues through to completion required
- Detail oriented; analytical and problem identification and resolution skills required
- Strong data analysis skills; ability to discern patterns and trends required
- Excellent collaboration skills and the ability to influence management decisions required
- Excellent communication skills (verbal, written, presentation, interpersonal) with all types/levels of audience required
- Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.) required
- Knowledge of/proficiency with applicable systems and platforms (FACETS, TruProvider and Salesforce) required
- Exceptional organizational and project management abilities to handle multiple priorities preferred
Security Disclosure
If you receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.
Pay Disclosure
At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.
EEOC Statement
We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.
Sponsorship Statement
EmblemHealth may provide work visa sponsorship depending on factors such as business unit requirements, position nature, costs, and applicable laws and regulations.