Risk Management Specialist jobs in Cleveland, OH

JOB SUMMARY: The primary role requirements include ensuring seamless integration and delivery of insurance services for self-funded middle-to-large market health plans. Duties will include a blend of project management, forward-facing relationship and trust building with Human Resource professionals and their supervisors, often C-suite leaders, and deep understanding of insurance products and regulations. The ability to achieve success and excellence during implementation is a top priority and often the key to long-term client retainment. Superior communication skills and business acumen will always be a top priority. Must maintain a high-level of concern for timeliness, accuracy, and thoroughness with clients, members, and company personnel.

The primary objective is to oversee the successful implementation of insurance solutions tailored to meet the unique needs of each client group, with a focus on collaboration with the Account Management team and Procurement Specialist for comprehensive risk management. Working in collaboration with sales, vendors, leadership, and nurse navigators to achieve the best member and client outcomes will be a common test of effective multi-tasking and communication abilities.

ESSENTIAL FUNCTIONS:

• Coordinate and lead the onboarding process for new client groups, understanding their insurance requirements, organizational structure, and employee demographics.

• Work with a high degree of autonomy on scheduled responsibilities and completing tasks in predetermined timelines.

• Coordinate the renewal process for current client groups, overseeing any significant changes to their insurance plans and ensuring smooth transition and adaptation to new operational procedures.

• Own issues through to resolution on behalf of clients through a comprehensive and timely follow-up with all necessary parties.

• Develop comprehensive implementation plans, outlining timelines, tasks, and responsibilities to ensure timely and effective delivery of insurance services; monitor progress and address any deviations from the plan.

• Receive and facilitate communication between clients and vendors.

• Develop and maintain positive working relationships with vendor partners.

• Interact with clients, vendors, case managers, and healthcare providers through inbound and outbound calls/emails.

• Maintain patient privacy and patient confidentiality under requirements under federal and state laws including HIPAA and in accordance with company policies.

• Manage the contract placement and renewal including vendor agreements.

• Manage all annual events and on-going support actions, including but not limited to pre-renewal planning, open enrollment, plan & eligibility audits, compliance management, billing & administrative support.

• Attend client meetings, including travel.

• Work with and collaborate with vendor partners and account service teams of Health Rosetta.

• Provide training and education to client’s administrative staff.

• Ensure compliance with internal quality controls and procedures.

• Provide support to marketing, analytics, & technology team.

• Consistently demonstrate positive attitude while working in a team environment.

• Must be comfortable working in a fast paced & highly demanding environment with precision accuracy.

• Provide positive, prompt, accurate, and courteous service to clients.

• Assist with new and renewal business, prepare proposals, presentation packets and maintain underwriting and RFP needed information.

• Maintain each client’s open issues log via ticketing system.

• Check new and renewal contracts and policies for accuracy in rates, typing, coverage, signatures, and input these transactions into company files. Ensure that these items are delivered to the client or advisor for delivery.

• Receive phone calls from clients and companies regarding insurance, claims billing, or administrative needs, and comply with the request and/or refer to the advisor when necessary.

• Maintain a system to follow up on outstanding orders, correspondence, reports, and follow up on overdue and ongoing items.

• Maintain electronic files in an orderly, up-to-date manner consistent with the company policy.

• Participate in seminars, webinars, and conferences for skill and knowledge development.

• Review quarterly data and reporting with plan sponsor.

• Perform other related duties as assigned.

JOB EXPECTATIONS:

• Communicate in a professional manner both verbally and written.

• Attend meetings as necessary.

• Be responsive to client and team member concerns (Goal for response or follow up is < 24 business hours).

• Independent problem solving and critical thinking is required.

• Proficiency with Excel, Outlook, Word, Adobe Pro, and Power Point is required.

• Travel to visit clients is required. (Up to 25%.)

PHYSICAL REQUIREMENTS: This is a fast-paced setting that requires quick thinking and decision making. Involves standing, sitting, walking, and extended periods of time on the phone and computer.

EDUCATION, TRAINING, AND EXPERIENCE:

• Current and active Accident and Health Insurance License is preferred.

• A Bachelor of Science in business or another relevant field is preferred.

• Excellent oral and written communication, collaborative and facilitative skills, customer service/relations focus organization skills are required.

• Microsoft office proficiency is required.

• 5 years insurance knowledge and experience are required.

NECESSARY SKILLS:

• Critical thinking

• Motivated problem solver

• Autonomy

• Time management

• Microsoft Excel, Word, and PowerPoint

• Presentation skills

• Organization

• Communication

Job Type: Full-time

Pay: $75,000.00 - $90,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Compensation package:

• Yearly bonus

Experience level:

• 5 years

Schedule:

• 8 hour shift

Work Location: Hybrid remote in Ashtabula, OH 44004