The Health Care - Medical Policy/Behavioral Health Clinical Coordinator role is primarily an operational role but offers opportunities for strategic input by offering clinical expertise and knowledge of the healthcare industry, insurance plans, and related laws and regulations. They will work as part of a team to assist in the development and delivery of innovative health care solutions, targeting both Non-Represented and Represented employees. They will support the Manager of Health Care initiatives, while maintaining key relationships with the broader integrated Health Care team, Human Resources, Finance, and key vendors. The successful candidate must bring an ability to navigate across a rapidly evolving, high-growth business in the North American region.
Key Responsibilities:
Manage/support all self-insured medical and behavioral health vendors. Work closely with carriers to ensure plan benefits are accurately administered for all non-bargaining and bargaining unit health care plans. As employee/HR/Vendor interface, resolve employee claim and eligibility issues and perform root cause analysis to determine improvement opportunities and implement identified process improvements
Manage health care inquiries/appeals/reporting. Work closely with employees, medical carriers, medical plan Chief Medical Officers to resolve complex issues and appeals. Provide information to members and carriers. Present appeals to the FCA Health Care Review Committee for review and decisions
Ensure compliance under ERISA, DOL, PPACA and other related laws/regulations as it relates to health and welfare plan documents and regulatory guidelines. Work closely with internal and external legal counsel to review regulatory language in all documents before distribution
Support Annual Enrollment. Collaborate with benefit administration team and external vendor partners to deliver presentations, plan information and employee education.
Prepare Benefit Grids for carrier plan benefit updates and changes. Review content and clinical necessity and make recommendations to the V.P, Health Care, Disability & Group Insurance regarding plan changes
Provide clinical expertise and benefit knowledge to support Health Care Subcommittee in UAW negotiations
Coordinate Annual Supplier Reviews. Prepare agendas and coordinate meetings with suppliers and Stellantis health care team
Represent Health Care Team in support of Annual Health Fairs, HR, and Wellness Initiatives. Prepare and present materials in support of key initiatives
Update Health Plan Comparison charts with compliance team annually for all health and dental plans for all employee groups
Coordinate monthly Joint Benefit Conference meetings. Work with UAW Benefits Representatives to prepare agendas and materials for monthly meetings between Health Care Management team and UAW
Knowledge Base:
Experience in Health and Welfare benefits administration for ERISA and non-ERISA benefit plans
Demonstrated ability to handle confidential employee information and materials with discretion and good judgment
Strong work-organization and project management skills, excellent problem-solving and critical thinking, ability to oversee projects to ensure deliverables are met and key stakeholders are kept informed
Excellent written, verbal, and interpersonal communication skills
Comfortable working with a virtual benefits team and building relationships remotely
Understanding of medical and behavioral health plan benefit administration
Basic Qualifications:
Bachelor's degree
5 + years of experience in benefit administration of ERISA & Non-ERISA plans
Aptitude to work in a fast-paced, entrepreneurial environment
Strong analytical skills with an ability to drive change using data
Strong written and verbal communication skills to professionally and effectively interact with staff, colleagues and senior management
Capacity to work with labor unions
Percent Travel: 0-20%
Preferred Qualifications:
Bachelor's degree in Nursing or related clinical field
5+ years of experience in clinical setting
Experience with health plans or third-party administrators
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled.
