Health Care Service Corporation

• Provide timely and accurate service to customers (primarily active employees) • Assist in processing HR documents, i.e. benefit, salary, and status changes • Provide information on a wide range of human resources programs and services (via phone, chat, AskHR cases) • Expedite referral of complex issues and sensitive inquiries to the appropriate area for resolution including, but not limited to, benefits, leaves of absence, payroll, HR policy, training, and work-life programs

• Responsible for provider recruitment and contracting of national ancillary providers including large or complex dialysis, laboratory, home infusion, and durable medical equipment providers, for all HCSC plans and lines of business • Develop proposals and negotiate contracts • Develop and maintain relationships with providers • Responsible for education of providers and for ongoing provider service • Provide subject matter expertise to improve efficiencies and results

Role Description This position is responsible for identifying and mitigating enterprise wide risk through guiding business leaders on effective solutions for addressing corrective action, conflict resolution, and leaves and accommodations; conducting thorough investigations into employee concerns; assisting leaders in identifying solutions related to people care that will enable them to drive business results; leading the development and administration of HR policies, procedures, and tools to effectively support business leaders to promote positive employee relations. We cannot consider candidates from the following states: New York, California, Hawaii, or Alaska. Qualifications - Bachelor’s Degree or 4-6 years in human resources, preferably, employee relations, or closely related field - Counseling, coaching, and conflict resolution skills - Understanding of HR policies and procedures and federal and state employment and labor laws - Ability to identify issues and implement creative solutions - Clear and concise verbal, written, and interpersonal skills with all levels of management and employees - Establish and maintain solid working relationships and networks with various levels of employees and management Requirements - Demonstrated experience in Employee Relations, including issue resolution, investigations, and stakeholder consultation - Proven background supporting a large, complex enterprise, including work across multiple states and jurisdictions - Exceptional influencing, leadership, and communication skills, with the ability to engage effectively at all organizational levels - Strong public speaking, presentation, and professional writing skills - Must have working knowledge of the Microsoft Office Suite (e.g., Outlook, Word, Excel, PowerPoint) Benefits - Health and wellness benefits - 401(k) savings plan - Pension plan - Paid time off - Paid parental leave - Disability insurance - Supplemental life insurance - Employee assistance program - Paid holidays - Tuition reimbursement - Other incentives Company Description At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards .

• Managing a team of sales personnel handling new Supplement Benefit sales through HealthSpring’s National FMO Broker Partners • Implementing new sales goals on a quarterly basis • Ensuring the achievement of new sales goals each quarter • Ensuring positive and productive working relationships with our Topline National FMO Partners, their downline agents and agencies, our Local & Regional sales leaders, as well as various matrix partners across the company

• Develop and manage provider contracting and servicing strategies as well as value based care programs for a specific region. • Accountable for the maintenance, development, negotiation and successful completion of provider network participation contracts. Ensure appropriate coverage of networks for locations. • Oversee the contracting operations for professional providers and hospitals, for group, government and retail programs. • Achieve competitive advantage in discounts and access through contract negotiations and effective relationship management. • Develop strategies, draft agreements and negotiate contracts for newly recognized categories of providers. • Oversee the analysis and reporting required to develop payment strategies and take corrective action as needed. • Accountable for resolution of issues and contractual disputes. • Ensure staff meets/exceeds goals, objectives and initiatives. Ensure staff is trained, positions are filled, and employees receive communications on changes, etc. • Accountable for budget, operational reporting and financial reporting. • Maintain effective communications and provide support to regional counterparts in sales, marketing, and account management. • Communicate and interact effectively and professionally with co-workers, management, customers, etc. • Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies. • Maintain complete confidentiality of company related business. • Maintain effective communication with Vice President, Network Management regarding developments within areas of assigned responsibilities and perform special projects as required or requested.

• Managing and coordinating a high volume of service requests (phone, emails, portal, chat) from employees (and their immediate family) of our clients • Educating and assisting callers with understanding, navigating through, and obtaining value of their healthcare and wellness benefits • Providing direction in working through a variety of benefit issues

• Perform accurate and timely medical review of claims suspended for medical necessity • Initiate and/or respond to correspondence from providers or members concerning medical determinations

• Responsible for small, mid-size, and large provider recruitment and contracting activities for physicians, physician groups and facilities. • Develop and negotiate contracts. • Develop and maintain relationships with providers. • Ensure strategic coverage for assigned territory. • Responsible for education of providers and for ongoing provider service. • May be responsible for or assist with contracting or supporting services for large or complex groups/facilities. • Ability and willingness to travel within assigned areas of responsibility, including overnight stays.

• Creating reports, insights and analytics in support of the division. • Creating specifications for reports and analysis based on business needs. • Providing consultation to users and working on cross-functional teams. • Producing datasets and reports for analysis using system reporting tools. • Performing research and assisting in analyzing data related to the division’s strategic initiatives. • Interfacing between the business and divisional data teams to generate tools for building analysis and reports. • Working closely with customers to build relationships and understanding of data needs. • Analyzing complex business problems and issues using data from internal and external sources to provide insight to decision-makers.

• Managing the implementation, maintenance, and critical review and analysis of models, studies, and systems using actuarial principles • Developing complicated models and teaching others how to develop models • Developing written and oral presentations to drive delivery of information for decision making • Managing day-to-day projects that may include non-Actuarial departments • Deep understanding of one actuarial area or business segment