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CNO Financial Group Sr. Transparency Specialist in Carmel, Wisconsin

Worksite is hiring a Senior Transparency Specialist to effectively provide education and support to members as they navigate their employer-sponsored benefit programs. This role acts as a leader supporting the Transparency Supervisor with work distribution, escalation management, team training, and team support. The goal is to enable Optavise members to make informed cost decisions and benefit the most from their programs, as well as meet the business objectives and goals of the employer. Senior Specialists primarily receive incoming requests from members to research medical procedure cost inquiries that range from simple to the complex. The Senior Specialist will use the Optavise custom internal case management system and processes to deliver an exceptional member experience

As a Director Product Owner Sales Enablement , your responsibilities will include:

  • Provide first-line support to the Transparency specialists who require additional support with member interactions, requests, and complicated cases.

  • Support the Transparency Supervisor and Advocacy Manager by assisting in workflow management and daily/weekly work distribution among team members, escalation management, and team SME support.

  • Reassign cost cases based on need and timing

  • As part of the ongoing specialist training curriculum, provide hands-on training support, “on the floor” mentoring, and support regulatory changes that impact cost reporting. Support onboarding of new team members and serve as a mentor new Specialists and provide guidance/training as they learn the case management system, processes, and other helpful nuances for healthcare benefit education and cost transparency reports

  • Serve as a SME on the cost report process, including participating in policy or regulatory discussions to ensure all health care policies are being applied and updated in the cost transparency process.

  • Provide SME level healthcare education to members and their dependents regarding their employer-sponsored healthcare benefit programs, including but not limited to calculating and providing members with customized cost comparison estimate of their financial responsibility based on CPT codes and insurance coverage prior to service cost.

  • Consult on member liability clearly and accurately while adequately explaining concepts such as deductibles, coinsurance, and/or copayments and how they may affect the cost of care. Explain how non-covered and out-of-network services factor into out-of-pocket costs.

  • Consult with the most complex cases including complex cost issues; work unusual and VIP cases; initiate and manage cost escalations; and manage issues with employer sponsored health plans.

  • Serve as the “first-line-of-escalation” for more junior Specialists, providing expertise on how to manage certain cost issues or cases based on experience.

  • Collaborate effectively with the Nurse Advocates where a team of Optavise specialists, advocates and nurses work together to resolve complex cases or appeals (when costs are at issue)

  • Demonstrate knowledge of insurance benefits and the cost/payment area(s) of insurance companies. Explain how non-covered and out-of-network services factor into an out-of-pocket cost.

  • Using the Optavise custom designed case management system, consult with members who require help/guidance/actions with regards to their employer-sponsored benefit program(s). Navigate the tools necessary to create and generate cost comparison reports.

  • Conduct external outreach to providers, carriers, and other healthcare agencies to follow through on open case tasks and see a case through the execution of a custom, member-specific cost comparison report.

  • Research and call provider offices and/or medical facilities to source pricing, obtain costs, confirm affiliation.

  • Determine and execute the best resolution to assist members based on their unique needs or requests.

  • Collaborate with Senior Advocates and/or supervisors for escalations where additional support is required to support a member’s request.

  • Cross train on Optavise Advocacy case workflow and provide support on Open Enrollment activities, educating members and eligible employees on the benefits available to them as they make decisions, including eligibility, plan comparisons, and costs, as needed.

  • Support special projects and conduct external outreach calls as defined by the Optavise leadership on behalf of clients who require outreach on special programs, wellness initiatives, and support for Open Enrollment.

The Senior Transparency Specialist position is well-suited for you if you:

  • Ability to effectively translate complex healthcare nomenclature and situations that include HIPAA guidelines, PHI and PII guidelines, and current healthcare legislation that may impact employer-based benefit programs.

  • Ability to identify with high accuracy all medical coding (CPT and HCPCS) guidelines (using available tools and through experience).

  • Experience with or demonstrated ability to help lead teams and mentor colleagues using subject matter expertise .

  • Strong communication and writing skills and demonstrated ability to communicate complex information clearly and persuasively to provide education and support to all members and their dependents.

  • Ability to collaborate effectively with peers to provide excellent service to members through case resolution.

  • Excellent customer service and problem-solving techniques to identify issues, root causes and possible solutions.

  • Set expectations for time-sensitive follow ups, and how the issue will be managed, including possible outcomes.

  • Strong ability to explain complex issues to members.

  • Build rapport with member using friendly, courteous, and professional manner.

  • Maintain a positive attitude in the face of challenging or difficult situations.

Qualified candidates will have:

  • Bachelor's degree desired or experience in the health insurance field.

  • Minimum 6 years’ experience in health insurance, benefits, a provider setting, or other similar environment is desired.

  • Life, Health & Annuity Required Licensing and Coverage (Company will support applicants with obtaining license)

  • Active resident state health and life insurance license

  • Non-resident licenses as required for client assignment (company paid)

  • Active errors and omissions insurance (company paid)

  • Ability to be appointed by all major insurance carriers

  • Thorough understanding of health care delivery, previous experience with medical benefits and claims for either provider or payor perspective.

  • Previous experience in role using technology, multi-tasking and written/verbal communication is used to drive daily responsibilities.

  • Previous experience (or demonstrated ability) to lead teams.

At this time, CNO is not mandating its associates to be vaccinated against COVID-19 as a condition of employment. However, this is an evolving situation, in the future CNO may require its associates to be vaccinated as a condition of employment, subject to reasonable accommodations required by applicable law.

CNO Financial Group offices reopened in April 2022 and we will be pursuing a hybrid working model. Associates who live within a 60 mile radius of a corporate office (Birmingham, Carmel, Chicago, Philadelphia, Orlando and Milwaukee) will have access to come into that Office up to 2 days/week, and work from home at least 3 days/week. This role is full time work from home (WFH), also known as Remote. This role can be performed from any US based location within the central or eastern time zone. Work cannot be performed from outside of the United States.

CNO provides life and health insurance, annuities, financial services, and workforce benefits solutions through our family of brands and supported by our associates and agents. Our customers work hard to save for the future, and we help protect their health, income and retirement needs with 3.2 million policies and more than $35 billion in total assets. Our 3,400 associates, 8,600 exclusive agents and independent partner agents guide individuals, families and businesses through a lifetime of financial decisions.

We are financially strong and well positioned for continued growth, and we are grounded in our core values of Diversity, Equity & Inclusion (DE&I); Integrity, Customer Focus, Excellence, and Teamwork. We have offices in more than 260 communities in the U.S., including our headquarters in Carmel, Indiana, and corporate offices in Birmingham, Chicago, Philadelphia, Orlando and Milwaukee.

At CNO Financial Group, we’re always looking forward—to the security and stability we help create for our insurance brands’ customers, and the growth we create within our own company. We're looking for ambitious people who want to do more. We'll provide you with opportunities to grow your skills through challenging professional experiences.

If you're looking for a culture that encourages development, helps you reach your potential, and rewards you for your contribution, then CNO Financial Group is right for you. For more information, visit CNOinc.com.

ReqID: JR166192

Category: Administrative/Support

Job Type: Full-Time

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