Value-Based Reimbursement Specialist

Company :

Highmark Inc.
Job Description :

JOB SUMMARY

This job is responsible for key strategic initiatives for the Markets and Provider Transformation Organization supporting the matrixed teams that engage providers enrolled in the Organization’s value-based reimbursement programs and continuous improvement models. The incumbent plays different potential roles on a given project, to include elements of project leadership, problem-solving, data analytics, team development, communication, implementation, and project management. The incumbent often plays a central role in the development and execution of the strategy for a given initiative for transformation of workflows resulting in outstanding performance in the Organization’s value-based reimbursement programs ensuring that ROI targets as set by the Organization are met or exceeded. The position collaborates with various teams within data analytics and infrastructure to support the creation, optimization, and maintenance of self-service resources for providers, entities, and health systems within these programs. Works on multiple projects and has exposure to all parts of the Organization, and will play a supportive role in planning, communicating, and managing the market strategy.

ESSENTIAL RESPONSIBILITIES

• Participate in the development of strategic plans for the Enterprise and Markets and Provider Transformation and the key BU’s for the Organization’s value-based reimbursement programs and continuous improvement models. Lead or support key strategic initiatives across Enterprise and Markets and Provider Transformation for the Organization’s value-based reimbursement programs and continuous improvement models. Role will vary depending on initiative, but will include elements of team leadership, problem-solving, data analysis, project management, communication, implementation, and provider and/or provider-facing team education support. Will participate on a portfolio of projects.

• Serve as a subject matter expert working in concert with provider-facing teams to explain new programs and results to key provider partners as needed. Collaborate on product development and the creation, optimization, and maintenance of a self-service platform for providers, entities, and health systems within the Organization’s value-based reimbursement programs for both the commercial and government business with a focus on enterprise goals including but not limited to Government Markets (STARS, ACA, CHIP, Medicaid DE) and Enterprise Quality, Safety, and Values (Health Outcomes Measures). Provide actionable opportunities in provider transformation aimed at high-quality, cost-effective care while improving patient outcomes.

• Provide consultative workflow transformation and training/education services to matrixed teams supporting providers enrolled in the organization’s value-based reimbursement programs. Strong knowledge of risk adjustment methodologies and reporting/regulatory requirements and CMS Stars rating measures including HEDIS, CAHPS, Pharmacy, HOS, PQA, PQRS.

• Support development of the overall conceptualization, strategy alignment, and high-level design of new value-based reimbursement models for PCPs, specialists, and health systems across the Organization’s footprint, based on deep understanding and knowledge of trends in other areas of the country with both government and private payers. Programs will include but not be limited to pay-for-value programs, episode payments, prospective bundled payments, gain share and risk share models and will be implemented for the Organization’s Medicare Advantage, Medicaid, ACA, and commercial populations with the goal of maximizing quality while reducing healthcare costs.

• Support the identification of initiative impacts with other strategic initiatives to ensure alignment of the overall strategy to support the quintuple aim.

• Provide feedback and collaborate with the analytics team to ensure data points are accurate and provide meaningful, actionable data. Provide support to matrixed teams in the use of predictive analytic tools, user interfaces, population health management tools and other data-based platforms endorsed by the Organization.

• Support the team in identifying, clarifying, and resolving complex issues critical to the success of the initiative and play a role in shaping the culture and skill set of the Markets and Provider Transformation Organization.

• Other duties as assigned or requested.

EXPERIENCE

Required

• 5 years of Work experience in the primary care and the ambulatory care environment, healthcare insurance industry, healthcare administration in primary care, or healthcare consulting in primary care or population health management.

• 3 years of experience in data analysis, interpretation, and outcomes strategic plan development.

• 1 year experience with Medicare STARS, Medicaid HEDIS, risk revenue value streams, and population health management.

Preferred

• 7 years of experience in managed care, primary care management or other clinical setting.

• Experience in Lean, Six Sigma, TQI, TQC or other quality management certification.

• Experience in health plan provider network performance management, population health management, continuous improvement, or provider engagement models

• Experience influencing change in complex organizational systems.

​SKILLS

• Must be able to effectively resolve issues and problems across all areas of the corporation, by understanding corporate strategies, policy, and scope of authority

• Because of the broad impact of decisions that are made, must be knowledgeable and sensitive to many internal and external corporate issues

• Aptitude for a high visibility position demanding integrity, uncompromising professionalism, diplomacy and conflict management

• Basic project management skills

• Proactive in driving change and continuous improvement

• Demonstrated influencing and teamwork skills

• Strong quantitative, analytical, and time management skills

• Demonstrates a deep understanding of primary care practice operations and workflow across the continuum of variability in primary care and experience in managing provider and administrative leadership relationships

• Superior written and verbal communication skills and listening skills

• Ability to adapt engagement strategies to meet market needs

​
EDUCATION

Required

• Bachelors in Clinical or healthcare industry discipline OR relevant experience and/or education as determined by the company in lieu of bachelor’s degree

Preferred

• Masters

LICENSES or CERTIFICATIONS

Required

• None

Preferred

• None

Language (Other than English):

None

Travel Requirement:

Less than 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office- or Remote-based

Teaches / trains others

Occasionally

Travel from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Occasionally

Lifting:
up to 10 pounds

Constantly

Lifting:
10 to 25 pounds

Occasionally

Lifting:
25 to 50 pounds

Rarely

Disclaimer:
The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement:
This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

$67,
500.00

Pay Range Maximum:

$126,
000.00

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.

For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

California Consumer Privacy Act Employees, Contractors, and Applicants NoticeLife Insurance Advisor

Full-time | This is a Remote Opportunity

Amplify helps people build wealth through life insurance. We are the first direct-to-consumer platform that offers life insurance investment products where customers can invest tax-efficiently through their life insurance and access it for anything they wish. We are trailblazing the life insurance industry, helping families protecttheir financial futures.

At Amplify, our mission is to add value into our customer’s lives while they are still alive and well. That goal starts with building a strong and collaborative Amplify team. We strive to cultivate an environment that takes care of people, so those people can take better care of our customers. We want our team members to be here for the long haul and that’s why our job is to ensure a culture of transparency, inclusiveness, support, ownership, growth and learning opportunities.

We are working to make universal life insurance simple, efficient, and accessible for everyone. Backed by top venture capital firms including Crosslink, Anthemis Group, Greycroft, Transverse Asset Management and Conversion Capital, we are growing fast and looking for driven individuals to help our customers protect their loved ones and grow wealth.

About the Role

As a Life Insurance Advisor at Amplify, you will assist our clients with developing an insurance plan that fits their personal goals and family needs. You will be responsible for following up with customers that have completed our online needs assessment or started an application on our website with outbound calls.
Your goal will be to provide an outstanding customer experience by educating and guiding customers through their life insurance purchase:
explaining clearly how our policies work, when they make sense, diligently answering customer questions, and helping gather information required to submit their applications.

You will leverage our platform to generate comprehensive plans for clients that help protect their family and grow wealth through universal life insurance policies (Indexed Universal Life “IUL” & Variable Universal Life “VUL”) and term life. You will be at the cutting-edge of combining technology, finance, and the human-touch to modernize and streamline the most opaque segment of the life insurance industry.

We are seeking experienced and self-motivated sales professionals who desire the lead pipeline, training, and structure to set them up for success while building their career as a trusted advisor. To succeed, you should have a strong desire to meet and beat goals and bring a positive attitude to everything you do. We offer full time positions, remote-work, competitive base compensation, and uncapped commission opportunity – come help us build the future of life insurance for wealth!

Responsibilities

• Engage qualified, inbound leads provided by Amplify via outbound calling

• Answer customer questions via phone, sms, and email

• Understand and confirm customer needs through discovery

• Leverage our platform to generate recommended plans for customers and explain the benefits of those plans within the context of customer needs

• Educate clients on basics of life insurance, Amplify’s process, universal life insurance, how it works, and when it is suitable

• Assist clients with finding and customizing life insurance plans and illustrating scenarios

• Gather client information required to submit life insurance applications

• Partner with case managers and delivery team members to drive customer conversion

• Join and actively participate in team meetings and coaching sessions to improve sales technique and Amplify workflows

Experience

• 1+ years of sales experience via telesales and outbound calling

• 1+ years of experience as a life insurance agent with demonstrated success

• Must have a current and active Life Insurance License in at least 1 state

• Experience with Universal Life Insurance, specifically Indexed Universal Life (IUL)

• Strong communication skills and ability to articulate complex topics succinctly

• Experience leveraging CRM, Powerdialer, and other sales tools effectively

• Proactive, self-motivated with a drive to meet and beat objectives

• Basic knowledge of finance

Preferred Experience

• Familiarity with financial planning concepts and available tax-advantaged vehicles

• Interest in working weekend shifts occasionally

• Bilingual in English and Spanish

About Us

Founded in 2019 by life insurance industry veterans, Amplify has been changing the way we approach life insurance to build wealth ever since. Previously, life insurance policies were used by the wealthiest 1%. Now, with our innovative software and expert life insurance agents, Amplify is providing access to everyone.

Amplify offers an intelligent customer journey with frictionless policy customization, pre-underwriting, and in-force policy management in a streamlined digital customer journey. Amplify is the first digital platform tackling the $70B permanent life insurance industry with a vision to launch a life insurance product that bridges health and financial wealth.

Amplify is an equal opportunity employer. We value a diverse workforce and an inclusive culture. Amplify encourages applications from all qualified individuals without regard to race, color, religion, gender, sexual orientation, age, national origin, marital status, citizenship, disability, or veteran status.Full Time | This is a Remote Opportunity

• *Must have Active Life Insurance License to Apply**

Job Type:
Permanent

Pay:
$37,
400.00 – $110,
000.00 per year

Benefits:

• 401(k)

• Dental insurance

• Health insurance

• Paid time off

• Parental leave

• Vision insurance

• Work from home

Supplemental Pay:

• Bonus opportunities

• Commission pay

Experience:

• W2
telesales life insurance:
1 year (Required)

License/
Certification:

• Life Insurance License in at least 1 state (Required)

Work Location:
RemoteJoin our dynamic team and immerse yourself in an environment that’s all about support, fun, and creating unforgettable memories that last a lifetime! We firmly believe that while things may fade, experiences are forever priceless. Explore a world of growth opportunities, top-notch training, enticing company perks, and the flexibility of working hours tailored to your lifestyle.

You’ll embark on a thrilling journey, orchestrating and planning dream vacations for our clients. Dive into the excitement of collaborating with an incredible team, utilizing data analysis to stay ahead of travel trends, and ensuring every client experience is nothing short of exceptional. If you’re a self-starter who thrives in a fast-paced, challenging environment, this could be your dream business.

Responsibilities:

• Effortlessly collect traveler information

• Safeguard client information with the utmost confidentiality

• Seamlessly process deposits and payments

• Verify names and addresses with precision

• Maintain up-to-date client contact information

• Stay abreast of the latest travel restrictions

Embark on this journey with us! If you’re 18 years or older, residing in the United States, Mexico, or Australia, and equipped with a smartphone or computer with reliable internet, we want you on our team!

Indulge in a flexible schedule with fantastic benefits! Whether you’re seeking a full-time or part-time role, relish in discounts, flexible hours, and professional development assistance.

Your adventure begins now! We’re seeking enthusiastic individuals comfortable working with minimal supervision. If you’re eager to learn, be coachable, and become a vital part of our incredible team, don’t miss out on this opportunity!