GEHA (Government Employees Health Association, Inc., pronounced G.E.H.A.) is a nonprofit member association that provides medical and dental benefits to more than two million federal employees and retirees, military retirees and their families. We celebrate diversity and are committed to creating an inclusive environment for all employees. GEHA has one mission: To empower federal workers to be healthy and well. Offering one of the largest medical and dental benefit provider networks available to federal employees in the United States, GEHA empowers health and wellness by meeting its members where they are, when they need care. We serve our members with products they value and a personalized customer experience, sustained by a nimble and efficient organization. Provides technical oversight to Health and Business staff on correspondence and contracts, responding to questions, complex service issues, demographic data and workflow issues. Assists department with special projects, implementation and execution of new programs and processes. Analyzes department production reports, turnaround time and various department data. SKILLS Reviews production and quality results to ensure that department standards and goals are being met. Develops and prepares daily, weekly or monthly reports as needed. Makes adjustments to tracking software as needed. Researches network service issues. Tracks priority issues and appeals. Coordinates with Senior Contract Specialist and supervisor to determine appropriate action needed for resolution or resolves issues. Analyzes and investigates par/non-par, balance billing, member appeals, provider appeals and quality assurance issues and coordinates with appropriate parties to resolve issue. Works with Senior Contract Specialist or Supervisor to implement workflows related to implementation activities. Creates and make changes as needed to network management desk level procedures. Reviews Network reports for potential non-compliance of access to care requires needed to meet OPM contractual requirements. Identifies error trends and determine training needs. Creates documentation and facilitate this training as needed. Assists with projects resulting from network pricing adjustments, GEHA system issues, and benefit changes. This includes determining appropriate workflow, resources needed and coordinating with internal departments to insure minimal impact on Claims division or clients. Works with Senior Contract Specialists to review audit results and appeal when issues are identified. Addresses daily reports received from internal GEHA areas, leased networks including, but not limited to network claim reports. Provides support to GEHA staff in regards to projects associated to Accreditation. Other duties as assigned Requirements Requires two years of college (60 credit hours), additional years of qualifying experience may be considered in lieu of education Requires three –five years health or dental-care ,insurance administration experience Requires effective verbal and written communication skills to respond to members, providers, network vendors, internal contacts and GEHA Management Requires knowledge of MS Excel and Access Requires analytic skills to evaluate network, provider and member data Some travel may be required #LI-Hybrid Work-at-home requirements Must have the ability to provide a non-cellular High Speed Internet Service such as Fiber, DSL, or cable Modems for a home office. A minimum standard speed for optimal performance of 30x5 (30mpbs download x 5mpbs upload) is required. Latency (ping) response time lower than 80 ms Hotspots, satellite and wireless internet service is NOT allowed for this role. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information How we value you Competitive pay/salary ranges Incentive plan Health/Vision/Dental benefits effective day one 401(k) retirement plan: company match – dollar for dollar up to 4% employee contribution (pretax or Roth options) plus a 6% annual company contribution Robust employee well-being program Paid Time Off Personal Community Enrichment Time Company-provided Basic Life and AD&D Company-provided Short-Term & Long-Term Disability Tuition Assistance Program Please note that the salary information is a general guideline only. GEHA considers factors such as (but not limited to) scope and responsibilities of the position, candidate’s work experience, education/training, key skills, internal peer equity, as well as, market and business considerations when extending an offer. The annual base salary range for this position is $54,145 - $75,855 USD. GEHA is an Equal Opportunity Employer, which means we will not discriminate against any individual based on sex, race, color, national origin, disability, religion, age, military status, genetic information, veteran status, pregnancy, marital status, gender identity, and sexual orientation, as well as all other characteristics and qualities protected by federal, state, or local law. GEHA will not discriminate against employees or applicants because they have inquired about, discussed, or disclosed their compensation or the compensation of another employee or applicant. We are committed to creating an inclusive environment for all employees. Our diversity drives innovation deepens connections and strengthens our organization. GEHA is headquartered in Lee's Summit, Missouri, in the Kansas City area. We recognize the importance of balance and flexibility and offer hybrid and work-from-home options for many of our roles. An Executive Order was released stating that federal contractors must require COVID-19 vaccinations for all US employees. As a company that works on federal contracts, we have a legal requirement to comply with the executive order, if it is enforced. GEHA (Government Employees Health Association, Inc., pronounced G.E.H.A.) is a nonprofit member association that provides medical and dental benefits to more than two million federal employees and retirees, military retirees and their families. Offering one of the largest medical and dental benefit provider networks available to federal employees in the United States, GEHA empowers health and wellness by meeting its members where they are, when they need care. Among our core values is embracing diversity and inclusion, where we thrive by creating an environment in which each of our employees feels a sense of belonging, can engage their full potential and focus on enriching our people, culture and community. Your FUTURE is here with us –COME GROW WITH GEHA! Benefits start on day one! Great 401(k) match! Tuition assistance programs! Professional development! Advancement opportunities! For additional information, please visit GEHA Careers.