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Health Plan Operations Lead GetCoveredNJ

Company: NJ Department of Banking and Insurance
Location: Trenton
Posted on: January 15, 2022

Job Description:

In June 2019,Governor Phil Murphy signed legislation to establish a State-Based Health Insurance Exchange for New Jersey. This law was enacted with the aim of expanding residents' access to quality, affordable health coverage and care. The Department of Banking & Insurance (DOBI) has implemented the State-Based Health Insurance Exchange, Get Covered New Jersey (, which launched in November of 2020. A critical function of the State-Based Health Insurance Exchange, a division within the Department, is improving access to health coverage throughout the State.
The Department of Banking and Insurance seeks qualified candidates to serve as the Health Plan Operations Lead for the New Jersey State-Based Health Insurance Exchange. The Health Plan Operations Lead will report to the Deputy Director of Program Operations and serve as the main point of contact for health and dental insurance carriers offering plans through Get Covered New Jersey. This includes ensuring smooth enrollment operations across the Exchange and carrier processes and systems, providing technical and operational assistance and guidance in response to carrier questions and inquiries, and supporting the resolution of consumer issues related to enrollment, and other related operational needs.Examples of key responsibilities include:--- Coordinating across medical and dental carriers offering or seeking to offer coverage through Get Covered New Jersey to ensure systems, processes, and policies are aligned--- Managing the relationship with the participating carriers to ensure communication channels are maintained, responding to questions and resolving any issues--- Developing technical assistance and guidance documents to improve carrier relations, integration and management--- Ensuring programmatic policies and processes are consistent with federal Exchange regulations promulgated by the Centers for Medicare and Medicaid Services and with state laws and regulations issued by DOBI--- Managing annual qualified health/dental plan Exchange certification process--- Ensuring ongoing alignment and accuracy of enrollment data through clear enrollment policies and the monthly enrollment reconciliation process, in coordination with data specialists (specifically related to electronic data interface (EDI) transactions)--- Working to quickly escalate and resolve with carriers any consumer coverage issues in a timely manner, including updating consumer accounts within the Get Covered New Jersey system to remedy enrollment issues--- Reviewing system accuracy by validating premium calculations, tax credit calculations, and ensuring plan benefits and network providers are displayed and represented accurately to customers--- Overseeing operations related to the provider directory and pharmacy data, including coordination of regular provider directory data submissions--- Providing expert input to technical teams to develop and implement new system functionality related to carriers, including writing business requirements and reviewing system designs to ensure intended impact is realized--- Build and maintain relations with internal cross-functional teams and external business partners to support areas of responsibility
EDUCATION: Graduation from an accredited college or university with a Bachelor's degree
EXPERIENCE: At least three (3) years of experience in the health insurance industry or related government experience.
--- Knowledge of health insurance benefits, New Jersey's insurance rules, and individual and/or small group health benefit procurement.--- Knowledge and understanding of the health care industry, including the commercial insurance market, Medicaid, and other health delivery systems, and addressing or otherwise managing issues of access, affordability, and quality health care.--- Knowledge and understanding of the health insurance components in the Affordable Care Act (ACA), especially health insurance exchanges.--- Ability to communicate effectively, both orally and in writing, regarding complex or sensitive information or issues.--- Ability to manage multiple, diverse, complex projects, balance multiple priorities, and communicate progress--- Ability to analyze data, and conduct research to formulate and advise decision-making, issue resolution and policy development
LICENSE: Appointees will be required to possess a driver's license valid in New Jersey only if the operation of a vehicle, rather than employee mobility, is necessary to perform the essential duties of the position.
RESIDENCY REQUIREMENTS: In accordance with the New Jersey First Act, N.J.S.A. 52:14-7 (L. 2011, Chapter 70) , effective September 1, 2011, newly hired State government employees must reside in the State of New Jersey, unless exempted under the law. If you do not reside in New Jersey, you have one year after you begin employment to relocate your residence to New Jersey. Employees who fail to meet the residency requirements are subject to removal from employment.Interested applicants should submit a letter of interest, resume and three (3) professional references of your current or former supervisors or managers- please only provide references for those to whom you have reported in the workplace and those who have supervised or managed your work. Please provide your references' names, job titles and current contact information, including email addresses. All documents should be submitted in PDF format by January 18, 2022 to: Please include Posting #BIA-2021-109 in the subject line of your email.
NOTE: Foreign transcripts must be evaluated by a recognized evaluation service at your expense. Submit a copy of the evaluation with each application that requires a college degree or credits. For additional information, please refer to the Civil Service Commission website at:

Keywords: NJ Department of Banking and Insurance, Trenton , Health Plan Operations Lead GetCoveredNJ, Healthcare , Trenton, New Jersey

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