Contract Specialist

GEHA (Government Employees Health Association, Inc., pronounced G.E.H.A.) is a nonprofit member association that provides medical and dental benefits to more than two million federal employees and retirees, military retirees and their families. We celebrate diversity and are committed to creating an inclusive environment for all employees.

GEHA has one mission: To empower federal workers to be healthy and well.

Offering one of the largest medical and dental benefit provider networks available to federal employees in the United States, GEHA empowers health and wellness by meeting its members where they are, when they need care. We serve our members with products they value and a personalized customer experience, sustained by a nimble and efficient organization.

• Serve as the main point of contact for healthcare providers, addressing inquiries and concerns promptly.

• Resolve provider-related issues and disputes efficiently.

• Provide support to providers on policies, procedures, and issue resolution practices.

• Complete telephone records supplying all information necessary to resolve providers concerns.

• Actively engages in communication and response with internal and external customers.

• Maintain production and quality to ensure that department standards and goals are being met.

• Research network service issues.

• Coordinate with the Contract Admin and supervisor to determine appropriate action needed for resolution or resolves issues.

• Analyze and investigate all issue categories including quality assurance issues and coordinates with appropriate parties to resolve issue.

• Work with Contract Admin or Supervisor to implement workflows related to implementation activities.

• Create and make changes as needed to network management desk level procedures.

• Identify issue trends to assist with workflow updates or changes as needed. Assists with job aides and Desk Level procedures.

• Assist with projects resulting from network pricing adjustments.. This includes determining appropriate workflow, resources needed and coordinating with internal departments to insure minimal impact to payers or clients.

• Work with Quality Assurance Specialist to review audit results and appeal when issues are identified.

• Address daily reports received from internal areas and plan inquiries.

• Other duties as assigned.

Requirements: Education & Experience

• Requires two years of college (60 credit hours), additional years of qualifying experience may be considered in lieu of education.

• Requires three years health or dental-care, insurance administration experience or similar.

• Requires effective verbal and written communication skills to respond to members, providers, network vendors, internal contacts and GEHA Management.

• Requires knowledge of MS Excel and Access.

• Requires analytic skills to evaluate network, provider and member data.

• Candidates must reside in KC metro area.

Work-at-home requirements

• Must have the ability to provide a non-cellular High Speed Internet Service such as Fiber, DSL, or cable Modems for a home office.
• A minimum standard speed for optimal performance of 30x5 (30mpbs download x 5mpbs upload) is required.
• Latency (ping) response time lower than 80 ms
• Hotspots, satellite and wireless internet service is NOT allowed for this role.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

How we value you

• Competitive pay/salary ranges
• Incentive plan
• Health/Vision/Dental benefits effective day one
• 401(k) retirement plan: company match - dollar for dollar up to 4% employee contribution (pretax or Roth options) plus a 6% annual company contribution
• Robust employee well-being program
• Paid Time Off
• Personal Community Enrichment Time
• Company-provided Basic Life and AD&D
• Company-provided Short-Term & Long-Term Disability
• Tuition Assistance Program

While this is a remote opportunity, at this time GEHA does not hire employees from U.S. territories or the following states: Alaska, Hawaii, California, Washington, Oregon, Colorado, Wyoming, Montana, New York, Connecticut, Vermont, Pennsylvania, Maine.

Please note that the salary information is a general guideline only. GEHA considers factors such as (but not limited to) scope and responsibilities of the position, candidate's work experience, education/training, key skills, internal peer equity, as well as, market and business considerations when extending an offer.

GEHA is an Equal Opportunity Employer, which means we will not discriminate against any individual based on sex, race, color, national origin, disability, religion, age, military status, genetic information, veteran status, pregnancy, marital status, gender identity, and sexual orientation, as well as all other characteristics and qualities protected by federal, state, or local law. GEHA will not discriminate against employees or applicants because they have inquired about, discussed, or disclosed their compensation or the compensation of another employee or applicant. We are committed to creating an inclusive environment for all employees. Our diversity drives innovation deepens connections and strengthens our organization.

GEHA is headquartered in Lee's Summit, Missouri, in the Kansas City area. We recognize the importance of balance and flexibility and offer hybrid and work-from-home options for many of our roles.