Medicaid Business Partner
Guaynabo, PR
ABOUT US
At Triple S, we are committed to provide meaningful job experiences for Valuable People (Gente Valiosa). We encourage an environment of very high ethical standards, always excelling in service,
collaboration
among the company
, agility
to deliver timely, and embracing
accountability
for results.
When you join Triple S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our purpose to enable healthier lives. We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses.
Let's build healthier communities together, join now!
ABOUT THE ROLE
Serves as a steward for process optimization that is responsible for assisting the organization in navigating the Medicaid market, including the compliance and operational landscape, to respond to change to maintain the organization up to speed. Responsible for balancing business needs partnering with matrix teams to push forward Medicaid initiatives, operational efficiencies and financial alignment while remaining compliant with contract and regulatory requirements. The incumbent will be tasked with studying and recommending approaches to enable operational efficiencies and solidify internal and external partnerships as part of a corporate matrix model. Responsibilities include performing research of underlying root causes and implementing long term solutions to barriers necessary for the continuous improvement in customer experience and brand loyalty.
WHAT YOU'LL DO
Advises cross-functional interdisciplinary teams collaborating in the design and deployment of enterprise alignment strategies tied to the Medicaid line of business.
Provides stewardship and shared gatekeeper responsibilities to comply with Medicaid Business requirements assisting with fulfilling deliverables tied to the contract within the allotted time frame.
Uses a connect the dots approach to eliminate silos and fragmentation, integrating cross functional teams paired to test and adjust capabilities in alignment with Medicaid dynamics, contract negotiation strategy, special projects, corporate initiatives or other business needs.
Works with problems solving for issues of diverse scope and complexity ranging from moderate to substantial, promptly escalating identified vulnerabilities in day-to-day Medicaid processes leveraging team capabilities to course correct with agility.
Stays ahead of the curve by conducting in-depth studies and continuous participation in workshops, seminars and presentations that address market dynamics and promote ground-breaking compensation, service delivery models, product offering, marketing & sales strategies and other innovative, value-based proposals.
Assists with research of proposed policy and business models, preparation and submission of RFIs, Bid Proposals, position papers, surveys, requests for information responses, draft comment letters and audit filings required by federal and local authorities. Also collaborates with stakeholder organization requests for information or efforts to align market and proposed matters of public policy.
Facilitates organizational education on Medicaid market dynamics.
Performs other tasks as assigned by the supervisor which are essential to the position or are required in the ordinary course of business.
WHAT YOU'LL BRING
Bachelor's degree in business administration, communications, Political Sciences, Social Sciences, or related field plus 2 yrs of experience; or AD or 60-64 college credits plus 5 years related experience. Experience in the Managed Care business with at least some experience with Medicaid or Medicare Advantage Plans.
Project Management certification recommended but not required.
CLOSING DATE: 9/15/2024
It is company policy to seek for the qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, gender, gender identity, real or perceived sexual orientation, civil status, social condition, political ideologies, age, physical or mental disability, veteran status or any other characteristic protected by law. Drug-free company.
Equality Employment Opportunity/Affirmative Action for Minorities/Females/People with Disabilities/Veterans". Employer with E-Verify to verify the eligibility of employment of all the new employees.
We encourage Females, Veterans and Disabled to Apply
