Medical Vendor Specialist

<strong>AF Group (Lansing, Mich.) and its subsidiaries are a premier provider of innovative insurance solutions. Insurance policies may be issued by any of the following companies within AF Group: Accident Fund Insurance Company of America, Accident Fund National Insurance Company, Accident Fund General Insurance Company, United Wisconsin Insurance Company, Third Coast Insurance Company, or CompWest Insurance Company.</strong>

United States, USA

AF Group

<p class="p1"><strong>AF Group&rsquo;s focused and passionate team uses industry-leading best practices, analytics and resources to manage risk and minimize loss for our policyholders while strengthening businesses with our valued independent agent partners.</strong></p> <p class="p1"><strong>We strive to continuously increase the long-term value of our organization by outperforming our industry peers and fostering a culture of underwriting and claims excellence.</strong></p>

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Competitive Compensation and Benefits Package

Overview: <br />The Medical Vendor Oversight Specialist will provide day-to-day monitoring of relationships and partnerships to ensure the effectiveness of the programs or services offered by the medical vendors. This position will have a wide variety of specialized functions in support of MMP&amp;S with primary focus on cost containment vendors. This position will conduct due diligence on vendors, including sitting on the selection committee along with brand representatives. Responsible for generating, maintaining, analyzing, and reporting the results of audits and review of vendor, monitoring performance and compliance with the contract. Responsible for performing administrative tasks which may be highly confidential and sensitive in nature utilizing considerable independent judgment.<br /><br /> <p><strong>WORKING CONDITIONS:</strong></p> <p>Work is performed in an office setting with no unusual hazards. Minimal travel required with occasional overnight stays. Work is required at various times of the day and sometimes weekend work may be required.</p>
Responsibilities: <br /> <ul> <li>Takes the lead on vendor issues following submitted complaints and provides resolutions to meet internal performance standards.</li> <li>Direct, communicate, assign and manage work referred to vendors.</li> <li>Assist in implementing new vendor services, including communication and workflow/processes.</li> <li>Develop and manage vendor relationships including scheduling of meetings, greeting, and assisting vendors.</li> <li>Works closely with manager and brands on request for proposals and requests for information (this would be done if manager was not available or employee was given proxy from manager)</li> <li>Analyze documents and activities found in the queues such as OnBase, StrataCare, and/or Claim Center, etc.</li> <li>Inform appropriate staff of issues as necessary.</li> <li>Analyzes trends and reviews reports as requested or scheduled (i.e. metrics, scorecards, compliance, cost center, etc.).</li> <li>Prepares materials for presentation to all customers while maintaining confidentiality.</li> <li>Trains MMX team and internal customers on the use of reports located on the enterprise claims portal.</li> <li>Evaluate and monitor medical cost containment vendors based on service needs of the brands and ensure cost containment efforts are being met. Responsible for ensuring vendor compliance to corporate standards (i.e. timely submission, purchasing, timekeeping, licensing).</li> <li>Conducts annual vendor audits as scheduled or on an as-needed basis.&nbsp;Make recommendations for metrics used to measure vendor performance.</li> <li>Respond to calls, email communication, and provides information to vendors, insured, providers, or routes calls to the appropriate staff.</li> <li>Establishes and maintains effective working relationships with all internal and external customers. Develop a strong relationship and partnership with the claims department.</li> <li>Assist in the development of team goals.</li> </ul>
Requirements: <br /> <p><strong>EDUCATION:</strong></p> <ul> <li>Bachelor&rsquo;s degree in insurance, business, or a related field required.&nbsp;</li> <li>Relevant combination of education and experience may be considered in lieu of degree.&nbsp;</li> <li>College-level medical courses required.</li> <li>Continuous learning, as defined by AFHI&rsquo;s learning philosophy, is required.&nbsp;</li> <li>Certification or progress toward certification is highly preferred and encouraged.</li> <li>CAWC highly preferred.</li> </ul> <br /> <p><strong>EXPERIENCE:</strong></p> <ul> <li>A minimum of one year of experience in an insurance organization or completion of trainee program with demonstrated skills in the areas of medical cost containment vendors, oversight of vendors, auditing, and contract review.</li> <li>Workers' compensation experience preferred.</li> </ul> <br /> <p><strong>SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:</strong></p> <ul> <li>Ability and proficiency in the use of computers and company standard software specific to position.</li> <li>Knowledge of workers' compensation laws and regulations, including jurisdictional laws.</li> <li>Effective customer service skills.</li> <li>Ability to negotiate, build consensus and resolve conflict.</li> <li>Ability to manage multiple priorities and meet established deadlines.</li> <li>Attention to detail and analytical skills.</li> <li>Ability to work independently as well as within a team.</li> <li>Ability to work effectively in a multi-functional business unit.</li> <li>Excellent oral and written communication skills.</li> <li>Ability to comprehend consequences of various situations and to make appropriate individuals aware of these to facilitate decision making.</li> <li>Excellent organizational skills and ability to prioritize work.</li> <li>Ability to proofread documents for accuracy of spelling, grammar, punctuation, and format.</li> <li>Ability to effectively exchange information clearly and concisely, present ideas, report facts and respond to questions, as appropriate</li> <li>Ability to provide customer service by responding appropriately to inquiries or concerns from agents, policyholders, regulatory agencies, management, and employees.</li> <li>Effective presentation skills in a variety of settings.</li> </ul>