HEALTH PROGRAM SPECIALIST I

State of CaliforniaSacramento, CA
76d$6,623 - $8,290Hybrid

About The Position

This recruitment has been posted for more vacancies than currently exist as it may be used to fill additional identical vacancies which may occur within 180 days of the closing date of this bulletin. The Department of Managed Health Care's Help Center assists health plan members with health care issues and through its regulatory authority ensures that managed health plan members receive the medical care and services to which they are entitled. Under direction of the Standard Complaint Branch (SCB)'s Staff Services Manager III, the Health Program Specialist I is responsible for all phases and direct oversight of the SCB's operations and activities pursuant to the Knox-Keene Health Care Service Plan Act of 1975 (KKA), Title 28 of the California Code of Regulations, consumer/enrollee contracts, i.e., Evidence of Coverage, and program policies and procedures. The incumbent is responsible for the most difficult, complex, and sensitive consumer complaints and trend analysis, including providing recommendations to management, performing audits, and training.

Requirements

  • Experience working in the healthcare industry.
  • Experience with performing audits and compliance.
  • Ability to analyze complex medical or health care issues.
  • Effective communication and collaboration skills.
  • Ability to prioritize work and meet tight deadlines.

Nice To Haves

  • Experience working in a high volume, fast-paced environment.
  • Ability to independently solve problems.

Responsibilities

  • Oversee all phases of the SCB's operations and activities.
  • Handle complex and sensitive consumer complaints.
  • Conduct trend analysis and provide recommendations to management.
  • Perform audits and training related to health care service plans.

Benefits

  • Health insurance
  • Retirement plans
  • Paid holidays
  • Flexible work schedule
  • Telework options

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What This Job Offers

Job Type

Full-time

Career Level

Entry Level

Industry

Executive, Legislative, and Other General Government Support

Education Level

Bachelor's degree

Number of Employees

5,001-10,000 employees

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