GEHA Health

• Owns and oversees day-to-day process across the organization for their specific workstream, and ensures staff compliance with program workflows, clinical documentation, benefit resource allocation, and work distribution. • Responsible for oversight of complex or escalated case investigations and notifies department leadership as appropriate. • Coordinates department workload and identifies staffing needs or other resources to meet quality, quantity, and departmental goals. • Communicates changes in departmental processes and procedures to staff when necessary. • Serves as primary contact for staff, assigned internal and external programs and escalated issues. • Identifies potential process improvement opportunities across departments and makes recommendations to leadership as appropriate. • Audits staff processes and reviews cases with staff to assess compliance with established clinical and clinical support guidelines, workflows, and adherence to benefits structure and applicable regulations. • Consults with the leadership regarding complex and/or high-profile cases. • Recommends promotion, termination, hiring or reassignment of subordinates including scheduling and conducting informal and formal employee performance reviews, coaching and competency assessments. • Leads performance management, coaching, and talent development to build a high‑performing, engaged team. • Reviews performance issues with leadership and makes recommendations regarding level of discipline including developing performance improvement plans and delivering disciplinary action after reviewing with leadership and Human Resources. • Develops, implements, and maintains internal policies and procedures. • Coordinates department project planning to accommodate the company's annual business needs. • Works with management team to develop future programs and goals. • Collaborates with clinical staff and Medical Director regarding medical cases to ensure services are clinically appropriate. • Assists with development of department training materials. • Identifies educational opportunities for the staff. • Collaborates with Clinical Operations Division educator to provide educational opportunities. • Uses performance metrics and data analysis to identify trends, drive continuous improvement, and improve outcomes.

• Responsible for the execution of external and internal communications programs and projects including public relations, digital communications, HR and business unit communications counsel, and promotion of G.E.H.A’s community investment strategy • Establish processes, standards for execution, and set the bar for quality content that represents G.E.H.A well to both internal and external audiences • Work collaboratively with other members of the Communications team as well as team members from other support functions like Marketing and HR • Provide counsel to C-suite executives on a regular basis • Provide strategic counsel to executives and business partners • Manage communication channels (web, intranet, social media) • Participate in relevant communications/media events and conferences as assigned • Assist with implementation of crisis communications and issues management plans as needed

• Be accountable for Technology, Infrastructure, & Operations projects that impact company security and operational efficiency. • Maintain applications, systems, network, and/or telecommunications infrastructure to provide operational integrity and meet best practice guidelines for operational availability. • Assist all teams with development and communication of strategic planning, project planning and plans for ongoing development of technological solutions. • Provide some third-tier support for Service Desk and Tier-2 support for System Administrators. • Initiate projects and provide direction to management on technical matters. • Identify what needs to be done and act before being asked to or required by the situation. • Communicate with departmental personnel to ensure effective deployment of technologies. • Serve as technical resource for departmental and company-wide IT solutions. • Maintain knowledge of associated company management software, architectures, telecommunication products and services. • Support and collaborate with team members, software vendors, and other technical staff on project efforts to achieve implementation plans and timelines. • Understand the quality improvement process, create new processes and documentation, and produce desired outcomes with a minimum of effort.

• Conducts analysis, pricing and risk assessment to estimate financial outcomes. • Applies knowledge of mathematics, probability, statistics, principles of finance and business to calculations in health with a focus on dental plans. • Develops probability tables based on analysis of statistical data and other pertinent information. • Gaining exposure to some of the complex tasks within the job function. • Occasionally assists with modeling, identifies appropriate data sources, conducts analysis

• Provide accurate and data based information on company’s effectiveness and stability. • Research and analyze financial information to help the company make well informed decisions. • Write reports and monitor financial movements. • Work with management and senior leadership to provide guidance on strategy and business outcomes. • Consolidate and analyze financial data (budgets, income statement, forecasts etc.) taking into account company’s goals and financial standing. • Provide creative alternatives and recommendations to reduce costs and improve financial performance. • Support the annual budgeting process in conjunction with the Manager, FP&A. • Analyze project performance against expense and benefit expectations each month. • Assemble and summarize data to structure sophisticated reports on financial status and risks. • Develop financial models, conduct benchmarking and process analysis. • Conduct business studies on past, future and comparative performance. • Partner with management to understand financial reporting needs and desired outcomes. • Identify trends, advise company and recommend actions to a FP&A management based on sound analysis. • Develop reports and analyze nonfinancial data. • Incorporate financial data into this analysis when appropriate. • Track and determine financial status by analyzing actual results in comparison with budgets and prior periods. • Consult with management to guide and influence long term and strategic decision making within the broadest scope. • Reconcile transactions by comparing and correcting data. • Drive process improvement and policy development initiatives that impact the function. • Other duties as assigned.

• Lead, coach, and develop a team of Executive Escalation Specialists responsible for end-to-end resolution of complex medical and dental escalations. • Establish clear performance expectations, conduct performance reviews, and provide ongoing feedback and development planning. • Ensure appropriate workload distribution, coverage, and escalation protocols to meet service level and quality expectations. • Foster a culture of professionalism, accountability, discretion, and strong member advocacy. • Provide oversight and guidance on the most sensitive, complex, or high-risk escalations, including OPM grievances, leadership-referred cases, and compliance concerns. • Serve as a management escalation point for cases requiring advanced judgment or executive-level communication. • Ensure consistent, accurate, and empathetic communication with members, providers, senior leaders, and external stakeholders. • Establish and maintain investigative standards for root cause analysis, including claims review, eligibility validation, audit of calls and correspondence, and process flows. • Ensure escalations are resolved accurately, compliantly, and with long-term systemic solutions in mind. • Apply sound judgment to balance member experience, regulatory requirements, contractual obligations, and reputational risk. • Partner closely with operations, pharmacy, dental, customer service, and vendors to resolve escalations and mitigate risk. • Lead or participate in cross-functional working sessions addressing systemic issues surfaced through executive escalations. • Oversee tracking, reporting, and analysis of executive-level escalations, trends, and outcomes. • Identify recurring issues and systemic breakdowns in the member journey. • Translate insights into actionable recommendations to improve processes, claims accuracy, and customer experience.

• Assist in building and maintaining data models, reporting systems, and data automation systems that support key business decisions. • Assist in staging data from multiple sources for integration into models. • Monitors the performance of analytic solutions and reports issues to senior engineers. • Implements quality controls and departmental standards to ensure quality standards, organizational expectations, and regulatory requirements. • Develops and maintains documentation of models, user guides, policies, and procedures. • Assists with employee training on newly developed models. • Adhere Data Governance first mindset and ensure that all data is managed in accordance with HIPAA and departmental and corporate guidelines.

• Cultivate relationships with federal agency benefits officers and HR professionals to promote G.E.H.A offerings. • Represent G.E.H.A at local agency events, health fairs, and virtual sessions to drive member engagement and lead generation. • Collaborate with internal sales and marketing teams to align outreach strategies with regional goals. • Identify and attend high-impact events that support federal employee health and wellness education. • Deliver compelling presentations and product overviews tailored to federal audiences. • Track engagement metrics, lead conversion, and event ROI to inform future strategy. • Stay informed on federal benefits trends, agency needs, and competitive landscape. • Serve as a regional expert and advocate for G.E.H.A’s mission and services. • Collaborate with internal stakeholders to identify opportunities for process improvement, efficiency enhancements, and resource optimization within the sales management process. • Maintain accurate records and documentation related to contractor activities, expenses, and performance metrics, providing regular updates and reports to management as required. • Stay informed about industry trends, best practices, and regulatory requirements related to field sales, incorporating insights and recommendations into program enhancements.

• Represent GEHA at local health fairs and wellness events • Educate federal employees and retirees about GEHA’s medical and dental plans • Become a go-to resource in your community • Share educational materials, answer questions, and help make health benefits easier to understand • Travel locally and get reimbursed for mileage and paid for your time

• Evaluates member health metrics and professional resources to inform, develop, select, implement, and sustain targeted UM/CM initiatives and programs. • Evaluates member level information regarding prospective Care Management or Utilization Management to determine whether intervention is necessary to meet the member’s needs. • Refers member and providers to G.E.H.A resources and programs, as indicated. • Leverages a spectrum of hard and soft skills to collaborate with others across the service continuum to address member and provider daily and escalated needs. • Using effective engagement techniques, guides, assists and informs members when appropriate in a manner that maximizes their health plan benefits including but not limited to coordinating services, accessing in-network providers, closing gaps in care and altering health behavior. • Encourages members to participate in their health care decisions and assists members with researching treatment options. • Proactively identifies potential barriers, proposes and implements solutions. • Maintains a clear understanding of Plan Benefits. • Monitors and evaluates program effectiveness, tracks relevant metrics, and reports outcomes. • Performs in-depth and root cause analysis to identify barriers to care or member/provider experience.