Teacher Retirement System of Texas
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Health Plan Program Manager
role at
Teacher Retirement System of Texas
Base pay range $120,000.00/yr - $150,000.00/yr
This is an onsite position at our Austin office, with the opportunity to work from home one day a week based on business needs.
WHAT YOU WILL DO:
Conducts in-depth research and analysis of health care data to evaluate plan performance, identify trends, and develop actionable insights.
Synthesizes data into clear and concise analyses to inform decision‑making and drive improvements.
Utilizes data visualization tools and techniques to effectively present complex data to diverse audiences.
Develops and automates SQL queries in our internal data warehouse to extract claim data for use in analyses and dashboards.
Reviews reporting of health care data from external sources including from TRS' health care consultants, insurance companies, or other industry resources.
Analyzes provider reimbursement levels, high‑cost claims, costs by geographic area and place of service, and claim accuracy.
Identifies enrollment and cost trends, cost‑saving opportunities, and potential fraud, waste, and abuse.
Analyzes claim data to support invoice processing.
Conducts regular assessments of vendor activities to evaluate performance based on a good understanding of contracts and adherence to contractual obligations.
Reviews and validates vendor reports on health plan performance.
Reconciles financial guarantees relating to medical loss ratios, claim trends, pharmacy rebates and discounts, and ROIs.
Directs the work of vendors and monitors their progress on enacting TRS initiatives and information requests.
Addresses and resolves non‑compliance or subpar performance issues with vendors and escalates issues appropriately.
Leads meetings with vendors and manages agenda items.
PROCUREMENT AND CONTRACTING
Conducts market research to assess the products, services, and viability of companies that could potentially enhance TRS’ services.
Collaborates with internal stakeholders within the Health, Purchasing, and Legal & Compliance divisions, as well as with consultants to develop technical requirements, scopes of work, evaluation criteria, and procurement documents.
Acts as project manager to ensure procurement documents are produced timely and according to project workplans.
Negotiates contract renewal terms, requirements, and improvements.
Evaluates proposals from vendors and makes recommendations.
Communicates with stakeholders related to plan performance and initiatives, claims and utilization, provider network updates, pharmaceutical changes, marketplace situations and trends.
Recommends and implements strategies to optimize benefit delivery, plan performance, cost containment, and clinical outcomes.
Collaborates with internal and external auditors to conduct claim and vendor performance audits; tracks all audit findings through resolution.
Reviews legislative bills impacting the health plan and provides fiscal note analyses; implements bills that become law.
WHAT YOU WILL BRING: Required Education
Bachelor's degree from an accredited college or university in health information management, health care administration, public health, statistics, finance, business or a closely related field.
High school diploma or equivalent and additional full‑time experience in health plan administration, health data and/or health financial analysis, claim auditing or similarly related experience may be substituted on an equivalent year‑for‑year basis.
Required Experience
Five (5) years of full‑time directly related, progressively responsible experience in administration of a health insurance plan, health insurance consulting, claim auditing, or similarly related experience.
Experience in analyzing and visualizing health care claims data.
A master's degree or doctoral degree in a directly related field may be substituted on an equivalent year‑for‑year basis.
Seniority level
Mid‑Senior level
Employment type
Full‑time
Job function
Analyst and Consulting
Industries
Government Administration
#J-18808-Ljbffr
Health Plan Program Manager
role at
Teacher Retirement System of Texas
Base pay range $120,000.00/yr - $150,000.00/yr
This is an onsite position at our Austin office, with the opportunity to work from home one day a week based on business needs.
WHAT YOU WILL DO:
Conducts in-depth research and analysis of health care data to evaluate plan performance, identify trends, and develop actionable insights.
Synthesizes data into clear and concise analyses to inform decision‑making and drive improvements.
Utilizes data visualization tools and techniques to effectively present complex data to diverse audiences.
Develops and automates SQL queries in our internal data warehouse to extract claim data for use in analyses and dashboards.
Reviews reporting of health care data from external sources including from TRS' health care consultants, insurance companies, or other industry resources.
Analyzes provider reimbursement levels, high‑cost claims, costs by geographic area and place of service, and claim accuracy.
Identifies enrollment and cost trends, cost‑saving opportunities, and potential fraud, waste, and abuse.
Analyzes claim data to support invoice processing.
Conducts regular assessments of vendor activities to evaluate performance based on a good understanding of contracts and adherence to contractual obligations.
Reviews and validates vendor reports on health plan performance.
Reconciles financial guarantees relating to medical loss ratios, claim trends, pharmacy rebates and discounts, and ROIs.
Directs the work of vendors and monitors their progress on enacting TRS initiatives and information requests.
Addresses and resolves non‑compliance or subpar performance issues with vendors and escalates issues appropriately.
Leads meetings with vendors and manages agenda items.
PROCUREMENT AND CONTRACTING
Conducts market research to assess the products, services, and viability of companies that could potentially enhance TRS’ services.
Collaborates with internal stakeholders within the Health, Purchasing, and Legal & Compliance divisions, as well as with consultants to develop technical requirements, scopes of work, evaluation criteria, and procurement documents.
Acts as project manager to ensure procurement documents are produced timely and according to project workplans.
Negotiates contract renewal terms, requirements, and improvements.
Evaluates proposals from vendors and makes recommendations.
Communicates with stakeholders related to plan performance and initiatives, claims and utilization, provider network updates, pharmaceutical changes, marketplace situations and trends.
Recommends and implements strategies to optimize benefit delivery, plan performance, cost containment, and clinical outcomes.
Collaborates with internal and external auditors to conduct claim and vendor performance audits; tracks all audit findings through resolution.
Reviews legislative bills impacting the health plan and provides fiscal note analyses; implements bills that become law.
WHAT YOU WILL BRING: Required Education
Bachelor's degree from an accredited college or university in health information management, health care administration, public health, statistics, finance, business or a closely related field.
High school diploma or equivalent and additional full‑time experience in health plan administration, health data and/or health financial analysis, claim auditing or similarly related experience may be substituted on an equivalent year‑for‑year basis.
Required Experience
Five (5) years of full‑time directly related, progressively responsible experience in administration of a health insurance plan, health insurance consulting, claim auditing, or similarly related experience.
Experience in analyzing and visualizing health care claims data.
A master's degree or doctoral degree in a directly related field may be substituted on an equivalent year‑for‑year basis.
Seniority level
Mid‑Senior level
Employment type
Full‑time
Job function
Analyst and Consulting
Industries
Government Administration
#J-18808-Ljbffr