What are the responsibilities and job description for the Contract Management Specialist 2 (Health Benefit Exchange) (NY HELPS) - 99904, 99910 position at New York State Department of Health?
Description
Duties Description
The incumbent will serve as a Plan Manager within the Plan Management Unit, reporting to a Plan Management Team Supervisor. The incumbent will oversee a portfolio of health insurance issuers participating in the New York State of Health (NYSOH), including Qualified Health Plans (QHPs), Essential Plans (EPs), and Stand-Alone Dental Plans (SADPs). The incumbent will serve as the Department’s primary liaison for assigned issuers and will be responsible for ensuring compliance with State and federal requirements, supporting strategic operational initiatives, and maintaining the integrity of health plan operations within the Marketplace.
Specific Duties Include, But Are Not Limited To
Minimum Qualifications
Reassignment: Current NYS Department of Health Employee with permanent or contingent-permanent status as a Contract Management Specialist 2 (Health Benefit Exchange).
Permanent Transfer Candidate
NYS employee with one year of permanent or contingent permanent service in a position allocated to a Grade 21 or above and eligible for transfer under Section 52.6 of the Civil Service Law.
Non-Competitive
A bachelor's degree and three years of professional experience in the direct administration of private or public health insurance or service coordination for public health insurance-eligible consumers within a state-regulated facility.
Substitutions: Associate degree may substitute for two years of specialized experience; bachelor's degree may substitute for four years of specialized experience; master's degree may substitute for five years of specialized experience; J.D. may substitute for six years of specialized experience; Ph.D. may substitute for seven years of specialized experience.
Preferred Qualifications: Demonstrated experience administering or overseeing health insurance plans, including regulatory compliance, plan operations, or health plan certification activities; Demonstrated knowledge of New York State of Health, Qualified Health Plans, Essential Plans, Medicaid Managed Care, or other government-sponsored health insurance programs; Demonstrated experience evaluating provider network adequacy, analyzing healthcare data, interpreting federal or state healthcare regulations, and applying policy guidance to operational decisions; Demonstrated ability to independently manage a portfolio of assignments, balance competing priorities, and lead complex operational or policy initiatives involving multiple stakeholders; Demonstrated experience fostering collaborative relationships through exceptional customer service, written and verbal communication, problem-solving, and teamwork with internal and external partners.
Additional Comments
When reviewing qualifications, omissions and vagueness cannot be interpreted in the candidate’s favor. Candidates are responsible for providing accurate and clear descriptions of their experience demonstrating how they meet the minimum qualifications.
This position is part of the NYS HELPS program. No examination is required.
We offer a work-life balance and a generous benefits package, worth 65% of salary, including:
If you require reasonable accommodation to complete a job application, a job interview or to otherwise participate in the hiring process, please contact by phone 518-486-1812 or email doh.sm.Reasonable.Accommodation@health.ny.gov to make a request.
The NYS Department of Health does not participate in E-Verify and does not sponsor visa applications.
For new State employees appointed to graded positions, the annual salary is the hiring rate of the position (beginning of the salary range). Promotion salaries are calculated by the NYS Office of the State Comptroller in accordance with NYS Civil Service Law, OSC Payroll rules and regulations, and negotiated union contracts.
Duties Description
The incumbent will serve as a Plan Manager within the Plan Management Unit, reporting to a Plan Management Team Supervisor. The incumbent will oversee a portfolio of health insurance issuers participating in the New York State of Health (NYSOH), including Qualified Health Plans (QHPs), Essential Plans (EPs), and Stand-Alone Dental Plans (SADPs). The incumbent will serve as the Department’s primary liaison for assigned issuers and will be responsible for ensuring compliance with State and federal requirements, supporting strategic operational initiatives, and maintaining the integrity of health plan operations within the Marketplace.
Specific Duties Include, But Are Not Limited To
- Serve as the primary Department of Health contact for an assigned portfolio of health insurance issuers participating in NYSOH.
- Review, evaluate, and certify Qualified Health Plans, Essential Plans, and Stand-Alone Dental Plans for participation in NYSOH by assessing compliance with applicable State and federal laws, regulations, contractual requirements, and Marketplace policies.
- Review and analyze provider network submissions, network adequacy data, and supporting documentation to determine whether health plans meet network adequacy standards required for Marketplace participation.
- Coordinate with Department of Financial Services, Centers for Medicare & Medicaid Services (CMS), Information Technology staff, contractors, and other Department program areas to implement operational, regulatory, and systems changes affecting Marketplace health plans.
- Manage multiple operational and information technology initiatives simultaneously, including system enhancements, testing activities, defect resolution, business requirements development, and implementation of new Marketplace functionality.
- Analyze the operational impact of new State and federal legislation, regulations, executive directives, and policy changes and assist in developing implementation strategies, business processes, operational guidance, and communications.
- Research, analyze, and resolve complex operational issues affecting assigned health plans by utilizing multiple integrated information technology systems, databases, reporting tools, and system interfaces.
- Review, investigate, and resolve complex consumer issues and escalated complaints by researching member accounts, analyzing enrollment and eligibility information, coordinating with health plans and program staff, and facilitating appropriate account corrections when necessary.
- Develop policy guidance, operational procedures, written communications, presentations, and training materials for health plans, internal staff, and external stakeholders.
- Monitor health plan compliance with Marketplace operational requirements, contractual obligations, and performance expectations through ongoing analysis of data, reports, audits, and issuer activities.
- Participate in strategic planning initiatives and cross-functional workgroups to improve Marketplace operations, business processes, consumer experience, and program effectiveness.
- Establish and maintain productive working relationships with health plans, State and federal agencies, contractors, vendors, and internal Department stakeholders while providing technical assistance and operational guidance.
- Perform additional duties as assigned in support of the New York State of Health Marketplace.
Minimum Qualifications
Reassignment: Current NYS Department of Health Employee with permanent or contingent-permanent status as a Contract Management Specialist 2 (Health Benefit Exchange).
Permanent Transfer Candidate
NYS employee with one year of permanent or contingent permanent service in a position allocated to a Grade 21 or above and eligible for transfer under Section 52.6 of the Civil Service Law.
Non-Competitive
A bachelor's degree and three years of professional experience in the direct administration of private or public health insurance or service coordination for public health insurance-eligible consumers within a state-regulated facility.
Substitutions: Associate degree may substitute for two years of specialized experience; bachelor's degree may substitute for four years of specialized experience; master's degree may substitute for five years of specialized experience; J.D. may substitute for six years of specialized experience; Ph.D. may substitute for seven years of specialized experience.
Preferred Qualifications: Demonstrated experience administering or overseeing health insurance plans, including regulatory compliance, plan operations, or health plan certification activities; Demonstrated knowledge of New York State of Health, Qualified Health Plans, Essential Plans, Medicaid Managed Care, or other government-sponsored health insurance programs; Demonstrated experience evaluating provider network adequacy, analyzing healthcare data, interpreting federal or state healthcare regulations, and applying policy guidance to operational decisions; Demonstrated ability to independently manage a portfolio of assignments, balance competing priorities, and lead complex operational or policy initiatives involving multiple stakeholders; Demonstrated experience fostering collaborative relationships through exceptional customer service, written and verbal communication, problem-solving, and teamwork with internal and external partners.
Additional Comments
When reviewing qualifications, omissions and vagueness cannot be interpreted in the candidate’s favor. Candidates are responsible for providing accurate and clear descriptions of their experience demonstrating how they meet the minimum qualifications.
This position is part of the NYS HELPS program. No examination is required.
We offer a work-life balance and a generous benefits package, worth 65% of salary, including:
- Holiday & Paid Time Off
- Public Service Loan Forgiveness (PSLF)
- Pension from New York State Employees’ Retirement System
- Shift & Geographic pay differentials
- Affordable Health Care options
- Family dental and vision benefits at no additional cost
- NYS Deferred Compensation plan
- Access to NY 529 and NY ABLE College Savings Programs, and U.S. Savings Bonds
- And many more...
If you require reasonable accommodation to complete a job application, a job interview or to otherwise participate in the hiring process, please contact by phone 518-486-1812 or email doh.sm.Reasonable.Accommodation@health.ny.gov to make a request.
The NYS Department of Health does not participate in E-Verify and does not sponsor visa applications.
For new State employees appointed to graded positions, the annual salary is the hiring rate of the position (beginning of the salary range). Promotion salaries are calculated by the NYS Office of the State Comptroller in accordance with NYS Civil Service Law, OSC Payroll rules and regulations, and negotiated union contracts.
Salary : $86,681 - $109,650