Health Plan Program Manager SR or Technical Lead

Teacher Retirement System of Texas (TRS)•Austin, TX

63d•$120,000 - $170,001•Hybrid

About The Position

With the Health & Insurance Benefits Division, you’ll be joining a passionate team of self-motivated change agents united by our mission: driving to design the delivery of high-quality healthcare for nearly three-quarters of a million active and retired Texas public educators. The healthcare industry is complex and we’re a team of problem-solvers who are up for the challenge. With a focus on innovation and collaboration to catalyze the market, we spend nearly $4 billion annually on healthcare to make a difference in our members’ lives. With a career at TRS, you’ll be empowered through a culture of continuous learning, front-line decision-making, coaching and mentorship to shape the future of our work, while transforming healthcare delivery for 1 in 41 Texans. We’re seeking an experienced health plan professional with a strong background in benefit optimization, healthcare data analysis, vendor management and contracting. The ideal candidate will have hands-on experience working with or for health plans and be familiar with commercial and Medicare plans, benefit contracts, and claims data—and be proficient in tools like SQL and Power BI for analyzing and visualizing complex claims data. This role also requires an understanding of self-funded and fully insured contracts, as well as the ability to interpret healthcare regulations and drive strategic improvements. The Health Plan Program Manager Senior is responsible for performing complex health plan management work to ensure the plan is running efficiently, benefits are being administered appropriately, and to promote the long-term stability of the health insurance plans. The incumbent will conduct and synthesize healthcare data analyses and research, monitor and evaluate the work of plan administrators, lead and develop procurement and contract documents, and provide actionable insights for improvement. This position will proactively work with Health Finance team, Health staff and agency employees. The Health Plan Technical Lead is responsible for performing highly complex health care related research, analysis, and contracting and vendor management work. The incumbent will analyze health care related data to support benefit decision-making and plan optimization, lead medical benefits procurement and contracting process for health care services, monitor plan administrator services and performance to identify and resolve issues, and provide technical expertise and coaching to staff supporting the medical plans. This position will proactively work with multiple vendors and consultants, the Health Finance team, Health staff, and agency employees. This vacancy will be filled at one of two levels - Health Plan Program Manager Senior or Health Plan Technical Lead. Selected applicant will be offered the position that most closely matches their education and experience.

Requirements

Bachelor's degree from an accredited college or university in health information management, health care administration, public health, statistics, finance, business or a closely related field.
High school diploma or equivalent and additional full-time experience in health plan administration, health data and/or health financial analysis, claim auditing or similarly related experience may be substituted on an equivalent year-for-year basis.
Five (5) years of full-time directly related, progressively responsible experience in administration of a health insurance plan, health insurance consulting, claim auditing, or similarly related experience.
Experience in analyzing and visualizing health care claims data.
A master's degree or doctoral degree in a directly related field may be substituted on an equivalent year-for-year basis.
CTCM Certification within 6 months of hire.
Bachelor’s degree from an accredited college or university in public health, actuarial science, mathematics, statistics, economics, data science, or related field.
High school diploma or equivalent and additional data visualization experience may substitute for the required experience on a year-for-year basis.
Seven (7) years of full-time experience in administration of a health insurance plan, health insurance consulting, claim auditing, or similarly related experience.

Nice To Haves

Advanced degree in actuary science, finance, mathematics, statistics, business, health care administrations, or closely related field.
Recent experience in health plan administration or consulting, pharmacy benefits, actuarial services, business finance, claim auditing, procurement and contracting.
CEBS Certification
Advanced degree in actuary science, accounting, finance, mathematics, statistics, business, health care administration, or closely related field.
Two (2) years of full-time directly related, progressively responsible experience analyzing financial, health care, and/or health insurance related data.
Recent experience in health plan administration, benefit consulting, actuarial services, business finance, accounting, or auditing.