Posting Salary: Salary commensurate with experience
Position Summary: The University is California's third largest employer in California with about 200,000 faculty and staff. UC Health's self-funded health plans play a significant role in helping the University retain funds spent on health insurance premiums by both the employer (UC) and employees within its own system. In 2014, the University of California launched UC Care, a self-insured PPO health plan. In 2015, UC Care spent only 7% of each premium dollar on administration compared with 15%-20% spent by commercial health plans. This plan provides medical and pharmacy benefits to UC employees, non-Medicare retirees and their families. UC Health is responsible for the administration of the plan. Beginning in January 2017, UC Health became responsible for two high-deductible and three additional Medicare plans that are self-insured for employees. Total membership in all these plans is approximately 85,000. A new self-insured plan is being created for about 10,000 medical residents and graduate fellows the 2018-19 academic year. Beginning in January 2019, a flex-funded employee HMO plan with ACO relationships with the UC medical centers will be offered with an enrollment of 107,000. UC Health provides financial management, population health management and strategic thinking to the medical centers for this plan.
This position is responsible for the daily administrative management and vendor relations of the self-funded health insurance plans, offered each year to UC employees, non-Medicare retirees, graduate students and their families. Serves as a system-wide subject matter expert of the self-funded plans, administering policies and overseeing the resolution of issues with a full understanding of practices and internal and external policies and procedures. Provides guidance in administering the system-wide organization's benefits programs regarding plan options, policy features, enrollment and other requirements. Problems/issues addressed are of a complex and diverse scope with little or no precedent, where management of issues or data requires in-depth evaluation of variable factors. Collaborates with colleagues from disparate disciplines and external business partners in a complex organizational structure. Having wide-ranging experience, this subject-matter expert is creative and effective in using professional concepts and divisional program objectives to resolve complex issues with system-wide impact. Works on complex issues with little or no precedent where analysis of situations or data requires an in-depth evaluation of variable factors. Exercises judgment in selecting methods, techniques and evaluation criteria for obtaining results. As subject matter expert this person, represents unit/management positions to faculty, unions and other interested constituents. Internal and external contacts often pertain to system-wide goals, plans and objectives. Erroneous decisions could have a serious financial and legal impact on the overall success of the program.
Other Special Conditions of Employment: Successful completion of a background check is required for appointment to this critical position.
Duty 1: Oversee daily operations of employee self- funded health plans with over 85,000 members, generating over $500 million in claims each year.
Subject matter expert for self-funded plans with local benefit offices and staff across the 10 academic campuses, five medical centers and three national labs regarding day-to-day plan operations, implementation/operational/administrative issues, benefit interpretation/ application, and high-level customer service concerns; triage issues and consult Director as needed for resolution.
Formulates, builds and establishes objectives and strategic plans with other high level managers to proactively address key program and legislative issues. Acts as a key team member in the strategic planning process.
Primary point of contact responsible for the daily financial operations and controls for the self-funded plans to ensure program solvency.
Creates timely and accurate reporting systems for executive management. Provides financial analyses and verifies report data to internal and external constituents and stakeholders on a regular basis.
Excellent interpersonal skills to effectively lead, motivate and influence others and develop and maintain high standards of customer service.
Creates and ensures timely and accurate reporting to executive management, including the EVP of UC Health, the Health Care Task Force (made up of faculty, union representatives, other staff employees), Joint Operating Committee with Human Resources and the Executive Steering Committee, the fiduciary body for the health plans.
Identifies and prioritizes key business issues and actively takes initiative on delivering impact and solutions related to plan design and administration.
Ensures that the program tracks to set resources/budget, scope, and timeline and holds others accountable by elevating issues to appropriate divisional leadership.
Employs strategic and analytical thinking, strong capability of project management and problem solving skills, sound judgment and a willingness to resolve issues and problems in a timely manner impacting overall plan efficiency, member experience and plan financials.
Leads the development and maintenance of the provider networks by ensuring adequate network area coverage and identifying provider gaps. Directs the work of consultants and vendors to determine financial impact and secure appropriate discounts as needed for participation.
Liaison with the UC Medical Centers Managed Care Directors regarding new UCMC affiliates, rate loading, provider changes, and resolution of plan administrator issues.
Responsible for the content maintenance of the plans' micro websites.
Leads development and ongoing maintenance of the self-funded plan Program Manual, including program description, goals, all pertinent plan documentation (SPDs/EOCs, Group Applications, banking documents, job descriptions, policies & procedures, etc.). Function:Oversight Percent: 50
Duty 2: Excellent collaboration and relationship management skills, including influencing without authority, collaborating with senior leaders, facilitation, and working as part of a global team related to periodic system-wide multivendor implementation and transition projects as well as ongoing daily operations.
Manage activities to ensure new programs and plan changes, as well as new and changing state and federal law/regulations, are correctly implemented by vendors.
Highly sophisticated ability to apply and leverage design thinking and customer experience strategies to improve effectiveness and transform insights into actionable value-added initiatives.
Serve as management interface between UCOP and assigned third party vendors, monitoring vendor performance and communicating with assigned vendors to ensure delivery of efficient and effective service and compliance with contract agreements.
Identify pertinent issues and contribute to formulation of system wide policy to support effective contract administration.
Proven expertise and prior experience in new vendor implementation.
Demonstrates ability to identify and efficiently lead cross-functional workgroups to equitable resolution.
Highly sophisticated skills in strategy development, benefits program design, systems planning and vendor management. Function:Vendor Relations Management Percent: 50
Job Requirements Bachelor's degree in Business Administration, Public Health Administration, Human Resources, Educational Administration, or an allied field.
In place of the above requirements, the incumbent may possess any combination of relevant education and experience which would demonstrate the individual's knowledge, skill, and ability to perform the essential duties and responsibilities listed above.
Principles and procedures of fully-insured and self-insured/self-funded health plan administration.
Requires interpersonal, service oriented, active listening and critical thinking skills.
Principles and practices required to develop, implement, and evaluate health and welfare benefit programs.
Windows and the Microsoft Office suite including word-processing, spreadsheet applications, project management and database programs.
Use original thinking and independent judgment to develop solutions reflecting the legal, policy, and operational needs of the organization. Apply initiative, resourcefulness and creativity in problem-solving.
Apply political acumen to intricate situations occurring in a complex, decentralized organizational structure. Able to establish and maintain trust, confidence, and effective working relationships with colleagues and individuals of diverse occupational and social backgrounds.
Work independently, following through on assignments with minimal supervision and balancing multiple projects simultaneously with demanding timeframes. Organize, coordinate and complete projects effectively and within deadlines, while upholding a penchant for detail and a commitment to accuracy.
Principles and processes of project management. Strong organizational skills with demonstrated ability to manage multiple projects and meet deadlines. Ability to lead and pursue projects independently while exercising good judgment and exhibiting a considerable degree of creativity.
Highly developed verbal and written communications skills. Concise/precise messaging and executive level presentation material design skills are critical.
Excellent ability to quickly evaluate complex issues and identify multiple options for resolution. Required
10 years experience managing the implementation and administration of health benefit programs, preferably self-funded plans. Experience working in an academic institution desired.
Experience working directly in or with health care institutions a plus.
Current literature, trends, and developments in the field of benefit program administration.
Legal regulations applicable to employee health insurance programs (FERPA, HIPAA, PPACA, etc.). Preferred
About us The University of California, one of the largest and most acclaimed institutions of higher learning in the world, is dedicated to excellence in teaching, research and public service. The University of California Office of the President is the corporate headquarters to the ten campuses, five medical centers and three Department of Energy National Labs and enrolls premier students from California, the nation and the world.
The University of California is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age or protected veteran status.