Chief Health Management Specialist

13 hours ago

Taguig, National Capital Region, Philippines beBeeHealthAnalyst Full time ₱5,500,000 - ₱7,000,000
Job Overview

This role provides critical support to health and benefits consultants in the US. As a key member of the North America client team, you will collect and analyze data to inform strategic business decisions.

Main Responsibilities
  • Analyze data for Non-Quantitative Treatment Limits (NQTL) portion of parity assessment, including attending meetings with internal teams and preparing NQTL data requests on behalf of clients.
  • Review vendor documents such as summary plan designs and summaries of benefits.
  • Monitor carrier responses to data requests and prepare initial reviews of responses for parity projects.
  • Determine results and recommendations for parity concerns and findings for various NQTLs; collaborate with technical reviewer to validate language accuracy.
  • Coordinate with project manager regarding sending requests, timing, status, and follow-up; validate completeness of responses and report issues impacting timelines.
  • Map carrier responses to the appropriate sections of NQTL documents; collaborate with senior reviewer and project manager for follow-up with carriers/vendors as needed.
Key Qualifications
  • Minimum 3 years of experience with US health and welfare plans, preferably in a benefits consulting or brokerage firm.
  • Understanding of US health plan utilization/case management processes, network management, credentialing, quality management, pharmacy prior-authorization processes, and health plan operations.
  • Basic understanding of Mental Health Parity regulations; intermediate knowledge of MS Office, particularly Excel and PowerPoint.
  • Excellent oral and written English communication skills; strong client service orientation and ability to respond effectively and in a timely manner.
Benefits

This role offers a unique opportunity to work with a dynamic team and contribute to the success of our organization.

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