What are the responsibilities and job description for the Health Plan Strategy Advisor position at the Chickasaw Nation?
We are currently looking for a Full Time Health Plan Strategy Advisor to join our Area of Healthcare Strategies team located at the Carl Albert Service Center working 8:00AM-5:00PM - Mo Tu We Th Fr.
Summary:
The Health Plan Strategy Advisor is responsible for guiding the strategic direction, design, and optimization of the organization’s self-funded employee medical plan. This role requires a deep understanding of medical plan structures, claims adjudication, provider reimbursement methodologies, and clinical program oversight. The Advisor works closely with leadership, TPAs, and external partners to analyze claims data, evaluate financial and clinical risks, and recommend plan design strategies that balance cost efficiency with quality of care. The position serves as a trusted subject matter expert ensuring that the plan sponsor’s goals and fiduciary responsibilities are consistently prioritized.
Responsibilities:
- Provides first class customer service - courteous and helpful to all internal and external customer types
- Answers questions in a courteous and professional manner
- Greets and engages with a smile
- Determines needs, seeks positive experience and outcomes
- Completes all training and development requirements and participates in continuing education opportunities
- Works in a collaborative and supportive manner to support the productivity and safety of the work area, team members and customers of all types
- Maintains general upkeep of work area and maintains a safe environment
- Maintains and promotes professionalism
- Punctual and consistent in meeting start time, work schedule, attendance and other assigned work time metrics
- Adheres to Chickasaw Nation dress code standards
- Maintains knowledge of and follows all laws, rules, regulations, policies and SOPs for assigned area, e.g. MICS, TICS, hospital standards, health codes, food sanitation, accounting principles, etc.
- Analyzes medical claims (CPT, HCPCS, ICD codes) to identify utilization trends, high-cost drivers, and opportunities for cost containment
- Builds and evaluates financial and disruption models to forecast the impact of plan design modifications, reimbursement schedules, or network enhancements
- Recommends plan design changes including benefit coverage adjustments, out-of-network reimbursement strategies, and clinical management programs
- Collaborates with TPAs, repricing organizations, and network partners to evaluate repricing methodologies, global/bundled payment strategies, and network leasing opportunities
- Provides guidance on precertification, utilization management, and step therapy programs to ensure alignment of clinical care with plan cost objectives
- Partners with internal finance, HR, and benefits leadership as well as TPA account managers, underwriters, and actuaries to ensure plan goals are achieved
- Interprets stop-loss, reinsurance, and network agreements to evaluate their financial and clinical impact on the plan
- Assess and recommends integration opportunities between the medical plan and pharmacy benefit management programs
- Prepares detailed financial and clinical reports, including benchmarking, trend analyses, ROI calculations, and renewal projections for leadership
- Participates in RFP processes for vendors, TPAs, or networks, as well as support contract review and negotiation efforts with a focus on plan sponsor benefit
- Ensures compliance with all federal/state healthcare regulations and privacy standards
- Stays current on industry trends in TPA services, medical management, and value-based reimbursement models
- Attends meetings, trainings, and workshops as directed
- Performs all other duties as assigned
Competencies:
Essential:
Essential:
- Ability to understand, interpret, and communicate relevant information to diverse audiences
- Able to follow instructions, both written and oral
- Able to adhere to all scheduling and attendance requirements
- Must be able to exert analytical and critical thinking skill
- Honesty, truthfulness, reliability, accountability
- Able to read, understand, apply, and retain knowledge of Chickasaw Nation, departmental, divisional and all other rules, regulations, policies, procedures and guidelines
- Applied knowledge of medical coding and billing guidelines
- Knowledge of contract language, structure, development and approval process as relevant to position responsibilities and scope
- Knowledge and understanding of third-party applications
- Knowledge of a clearinghouse to submit medical claims
- Demonstrates effective oral and written communication
- Excellent project management skills
- Able to verbally communicate in a professional and positive manner with other team members, departments, guests and management
Skills:
Essential:
Essential:
- Advanced Excel skills to include embedded links, pivot tables, query, etc.
- Capability in dashboard reporting tools such as PowerBI, Tableau, etc.
- Excellent presentation and communication skills
Experience:
Essential:
Essential:
- 4 years directly related experience
Education:
Essential:
Essential:
- Bachelors Degree in directly related field
Credentials:
Essential:
Nonessential:
Essential:
- Pass general background check
- Standard Driver's License
Nonessential:
- Physician Assistant
- Registered Nurse
- Certified Health Data Analyst
Working Conditions:
Essential:
Nonessential:
Essential:
- Pass pre-employment drug test
Nonessential:
- May work remotely