Director of Operations

The Director of Operations will be accountable for the Claims, Claims Acquisition, Enrollment, and Member Advocate teams working with PBA’s leadership team to set the course for PBA’s future. Must be an outgoing business leader who can observe, analyze, and continually improve the operation to ensure it runs as efficiently as possible for PBA's success. This role reports to the COO/Integrator. Please see below for a more in-depth overview of daily responsibilities and skills required for this position.

Responsibilities

• LMA (Lead, Manage and support a culture of Accountability) using the EOS model to continually develop future leaders.
• Developing, mentoring, and evaluating Operations staff including, but not limited to, annual reviews and Quarterly Conversations.
• Oversight and accountability of the entire Operations team which includes:
  • Member Advocacy (Customer Service)
  • Claims Acquisition
    • Claims Prep
    • PPO Liaison
    • Provider Maintenance
    • Mail Room
  • Enrollment
  • Claims
    • Claims Processing
    • Training/Auditing
    • Excess stop loss claims
    • Plan Loading
    • Medical Management navigation between PBA and UR Vendors
• Vendor management/documentation
• Strategic Planning: Develop and implement operational strategies that support overall business objectives.
• Process Improvement: Analyze and refine business processes, workflows, and policies to boost efficiency and performance.
• Financial Management: Manage operational budgets, control costs, and monitor financial performance metrics.
• Leadership & Supervision: Lead teams, set guidelines for staff, and foster cross-functional collaboration.
• Performance Monitoring: Track key performance indicators (KPIs), analyze data, and report on operational health to executives.
• Accountability: Holds departments accountable for goals, tracks metrics, ensures follow-through, and drives results.
• Resource Management: Oversee production, inventory, vendor relationships, and resource allocation.
• Reporting department activity to COO/Integrator on a weekly basis.
• Applying observations and feedback to continually improve PBA’s operation.
• Other duties as assigned.

Requirements for this position

• 7+ years managing, coaching, and directing larger teams in a similar service based or claims operation.
• 5+ years managing Third Party Administration Claims processing.
• Ability to travel for quarterly meetings and/or client engagements when necessary.
• Stoploss experience or knowledge a strong plus.
• Javelina claims system experience or knowledge a strong plus.
• Senior level organizational, analytical and accountability skills are necessary.
• Effective verbal and written communications.
• Demonstrated ability to get results through team members and management.
• Adaptability to new concepts and systems.
• Problem solver and critical thinker.
• Open minded with a desire to learn, grow and receive feedback in a welcoming way.
• Must be able to represent PBA’s Core Values and business procedures to vendors, brokers, and clients.

Benefits and Compensation

• PBA offers a wide range of benefits including medical, dental, vision, life insurance, AD&D, critical illness, accidental illness, FSA, disability and 401k.
• The range for this role is $175,000-$190,000 per year.

Account Executive

The Account Executive is an essential role that is responsible for client implementation and retention. This position requires an experienced individual with prior account management experience as it relates to Group Health Plans. This position will work with all operational departments within PBA to ensure a great client experience. This position is also outward facing and reports to the Director of Client Accounts. Please see below for a more in-depth overview of daily responsibilities and skills required for this position.

Responsibilities

• Oversee transition of new clients from prior administrator to PBA. Obtain all information related to company benefit plans and distribute to various departments. Complete all external vendor set up paperwork.
• Complete internal documentation and participate in internal and external transition meetings.
• Facilitate ongoing vendor file changes.
• Process requests for plan changes and group terminations. Distribute information to various departments.
• Act as a primary contact for client and broker contacts.
• Liaison between PBA departments with clients, brokers, and vendors.
• Attend meetings, including, but not limited to:
  • Prospective clients
  • Current clients
  • Brokers
  • Employee open enrollment/re-enrollment
  • Health fairs
• Oversee broker and client monthly reporting including set up of initial reports and responding to requests for additional monthly reports.
• Assist brokers and clients with ad hoc report requests.
• Performing other duties as assigned.

Skills required for this position

• 5+ years of experience managing accounts in a third-party administrative capacity.
• Must be able to maintain a positive work atmosphere by behaving and communicating in a manner so that you get along with peers, subordinates, clients, vendors, and management.
• Self-starter who is organized and able to handle multiple projects and due dates.
• Good problem solving and research skills.
• Proficient in Microsoft Office Suite products.
• Strong presentation and communication skills to large and small audience.
• Good understanding of benefit plans and government regulations, i.e., HIPAA, COBRA, ERISA, ADA, etc.

Work Environment

• This role routinely uses standard office equipment such as computers, phones, filing mechanisms, and photocopiers. Essential office equipment will be provided to perform the job duties remotely. The person in this role will be responsible for maintaining high speed internet.
• This role will require travel.

Benefits and Compensation

• PBA offers a wide range of benefits including medical, dental, vision, life insurance, AD&D, critical illness, accidental illness, FSA, disability and 401k.
• The range for this role is $85,000-$105,000 per year.

Sales Support Assistant

The Sales Support Assistant is responsible for supporting the internal operations of the Sales Support team. This position requires strong administrative skills and attention to detail. Please see below for a more in-depth overview of daily responsibilities and skills required for this position.

Responsibilities

• Creating and scrubbing prospect files for the Sales Support team in a timely manner.
• Communicating with the brokers on any missing information.
• Building accurate Word proposals using Qvidian for ASO quotes and PDFing them into presentations for the Sales Representatives.
• Sending out prospect declination letters.
• Responsible for analysis requests.
• Sending communications to Operations Support, confirming any issues with the prospect’s plan designs.
• Creating and sending out non-medical renewal groups’ fee letters, then posting rate pages to the intranet.
• Assisting with the end-of-month processes to include specific reports being run and sent out.
• Attending and participating in all team meetings.
• Other duties as assigned.

Minimum Job Requirements

• 2+ years Third Party Administration or Insurance experience.
• Must be able to maintain a positive work atmosphere by behaving and communicating in a manner so that you get along with customers, clients, co-workers, and management.
• Must be a self-starter who is organized and able to handle multiple projects and due dates.
• Ability to quickly learn and adapt to new concepts/systems.
• Proficient in Microsoft Office Suite products.
• Excellent verbal and written communication skills.
• Ability to meet project milestones and deadlines.
• Ability to prioritize projects throughout the day and transition to new procedures/focus with ease.

Essential Functions Statement

• The person in this position will work remotely and must have a dedicated space that is set free of distractions, quiet and private for HIPAA compliance.
• The person in this position must demonstrate strong attention to detail to be able to properly maintain various reports and documentation, and coordinate system setups and networks.

Benefits and Compensation

• PBA offers a wide range of benefits including medical, dental, vision, life insurance, AD&D, critical illness, accidental illness, FSA, disability and 401k.
• The range for this role is $23-$26 per hour based on prior experience.