Commercial Products Analyst I - Denver Health Medical Plan (* Hybrid Work Schedule *)

We are recruiting for a motivated Commercial Products Analyst I - Denver Health Medical Plan (* Hybrid Work Schedule *) to join our team!

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Being the heartbeat of Denver means our heart reflects something bigger than ourselves, something that connects us all:

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Department

Managed Care Administration

Hybrid Work Schedule

Job Summary

Assists the Commercial Products team with the maintenance and administration of the Denver Health Medical Plan, Inc. (DHMP) Exchange, including CO Option, and Employer Group products. This position will ensure compliance with all State and Federal-level regulatory requirements requiring strong attention to detail and the ability to independently research, interpret and apply regulatory guidance. Standard work also includes creating analyses and reports, assisting with project and implementation plans, developing marketing materials and providing input on policies and procedures for departmental activities. This position will routinely utilize multiple systems and data sources to complete work timely and accurately, as well as interact with all levels of management and employees, plan members, external consultants, and State and Federal representatives.

Essential Functions:

• Reviews all State and Federal regulations and policy changes, conducting independent research to understand regulatory intent and operational impact; then communicates and collaborates with program areas to support implementation. Supports in analysis and coordination of internal and regulatory audits and regulatory materials (handbooks, benefit information) and communications. Supports member experience through attending events and partnering with the Marketing team to ensure aligned messaging to educate and retain members. (30%)
• Works independently, with Commercial Products team and other Managed Care Departments, serving as liaison to interpret contractual or regulatory requirements, leading the effort to improve workflows, policies and procedures. Creates and compiles accurate and vetted reports, attestations and other submissions to the State and CMS. Sustains collaborative relationships and promotes meaningful dialogue with regulatory bodies, internal teams and community partners. (30%)
• Researches and resolves member and provider escalations, requiring familiarity with Commercial health insurance benefits and ACA/Exchange products (20%)
• Assists in setting strategic direction of projects, developing project plans, analytic support services and applicable technical/subject matter expertise to achieve organizational goals. (20%)

Education:

• Bachelor's Degree required

Work Experience:

• 1-3 years years of health care/plan experience with a preferred emphasis on Commercial health plan operations, regulatory issues, policy development or compliance required

Licenses:
Knowledge, Skills and Abilities:

• Substantial knowledge of managed care/health care administration, policy and compliance, particularly regarding Commercial health plan operations
• Ability to interpret and synthesize Federal and State regulatory requirements
• Proficiency in Microsoft Excel, including pivot tables, VLOOKUP, and other functions to analyze, reconcile and validate datasets
• Self-starter who works with limited supervision and guidance, demonstrating strong organizational skills and attention to detail
• Ability to define problems, collect data, establish facts and draw valid conclusions to implement solutions and ability to develop data requirements and work with operations teams and groups to extract, organize and analyze data and trends
• Critical thinking, strong written and verbal communication skills, and the ability to work collaboratively in groups
• Ability to work on multifaceted projects in conjunction with day-to-day activities
• Critical thinking, strong written and verbal communication skills, and the ability to work collaboratively in groups

Shift

Days (United States of America)

Work Type

Regular

Salary

$60,200.00 - $90,300.00 / yr

Benefits

• Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans

• Free RTD EcoPass (public transportation)

• On-site employee fitness center and wellness classes

• Childcare discount programs & exclusive perks on large brands, travel, and more

• Tuition reimbursement & assistance

• Education & development opportunities including career pathways and coaching

• Professional clinical advancement program & shared governance

• Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program 

• National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

Our Values

• Respect

• Belonging

• Accountability

• Transparency

All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.

Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver’s 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation.

As Colorado’s primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.

Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.

Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community.

Applicants will be considered until the position is filled.