Health Plan Operations Specialist

Jefferson Health

Philadelphia, Pennsylvania, United States of America
Not specified; not specified; comprehensive benefi...
Internal appeals process administration
Administrative hearing representation
Regulatory reporting obligations management
This role supports the Enterprise Office of Legal Affairs by managing internal appeals processes and representing the health plan at administrative hearings when directed

Job Summary

  • This role supports the Enterprise Office of Legal Affairs by managing internal appeals processes and representing the health plan at administrative hearings when directed.
  • The position requires coordinating regulatory reporting obligations and gathering necessary data from business units to ensure compliance with state insurance department requirements.
  • Jefferson Health offers a comprehensive benefits package including medical, dental, vision, retirement plans, and tuition assistance for eligible colleagues.

Matching Summary

This role supports the Enterprise Office of Legal Affairs by managing internal appeals processes and representing the health plan at administrative hearings when directed.

Salary

Not specified; Not specified; Comprehensive benefits package including medical, dental, vision, life, disability, retirement, and tuition assistance

Skills & Requirements

Must-have

  • Internal appeals process administration
  • Administrative hearing representation
  • Regulatory reporting obligations management
  • Contract review and negotiation
  • Independent stakeholder interface

Nice-to-have

  • Experience with enterprise contract platforms
  • Background in regulated insurance industry
  • Legal research capabilities
  • Policy development support experience

Key Requirements

  • Bachelor's Degree required
  • 5 years law firm or in-house legal experience
  • Health plan operations experience preferred
  • Experience managing annual reporting for regulated entities
  • Proficiency in Microsoft Office and database systems

Work Rights

Not specified

Tailored Resume

Cover Letter