Sr Project Coordinator
 Health Care Service Corporation | |
life insurance, parental leave, paid time off, paid holidays, tuition reimbursement, 401(k)
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 United States, Texas, Richardson | |
| 1001 East Lookout Drive (Show on map) | |
 Jun 13, 2025 | |
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At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job Summary - Responsible for researching and/or investigating complex sales related complaints which include but not limited to MAPD, PDP, and could include CSB.- Assist in training new Lead Analysts as they join the team on the end-to-end processes and functions of the department. - Responsible for assigned caseload which requires timely follow up to ensure completion of cases within tight frames in order to meet internal and CMS expected goals. - Demonstrates the ability to problem solve, identify root causes and make the proper recommendations to correct the root cause of the issue/complaint. - Makes outbound calls to gather information and/or communicate the resolution to the appropriated party regarding the member complaint. - Creates written correspondence letters to provide resolution to complaints when verbal contact cannot be made with the complainant. - Documents all case research notes and resolution actions, in the appropriate systems, within the required timeframes. - Communicates with other departments, when necessary, to resolve member issues. - Knows the formal and informal departmental goals, standards, policies and procedures, which includes familiarity of other departments within the organization that allows him/her to identify workflow efficiencies and process improvements across the organization. - Displays a positive attitude and reports problems and issues to management as appropriate. - Maintain professional knowledge of state and federal regulatory guidance, primarily the Medicare Communication and Marketing Guidelines to utilize in all functions, processes, and communications with agencies and business partners - Perform other duties as assigned by Sales Integrity Leadership - Work independently on complex issues related to business requirements and federal/state regulatory guidelines for the SDAP department - Manage, process, and document cases for the Sales Development Action Program and committees. The research findings are presented to the committee. - Involved in routine oversight and ad hoc duties for the Sales Development Action Program (SDAP) and Complaint Investigation Process - Responsible for sales support processes, including but not limited to complaint creation and submission, complaint tracking and reporting, CRM database updates and/or general sales support. - Conduct a thorough investigation of complaints (CTMs, CSVs, etc.) and escalated inquiries from customers that complained to CMS, the local department of insurance, Customer Service, etc. The position uses analytical skills, knowledge of CMS guidelines, scripts, MAPD/PDP benefit plans, provider tools, CRM and other company provided tools in determining if a violation actually occurred. Research and documentation is critical since it can affect not only the agent but the customer. Individual reports may be generated and analyzed in this research process in order to make recommendations and future actions in a proactive approach. Accurately resolve issues at hand and prevent future complaints from occurring. - Subject matter expert for complaint related issues for both internal and external partners including Sales, Sales Operations, Sales Account Management, CARL Escalations, or Broker Strategist teams. - Supports program development, maintenance activity and provides highly technical advice on regulatory issues - Serve as resource for compliance-related issues and reporting - Perform quality checks to ensure compliance with CMS policies and procedures - Perform ad hoc audits and projects for the department outside of normal duties - Negotiate or resolve complex issues with customers, internal agents and/or external matrix partners using consistent independent judgement and discretion and being assertive when necessary - Routinely coordinates data compilation requests, process communication updates and document maintenance projects - Be honest and respectful in all dealings with internal and external partners - Support 24/7 operation needs as required, including weekends Required Job Qualifications:
Preferred Job Qualifications:
This is a Telecommute (Remote) role: Must reside within 250 miles of the posted office. #LI-MW2 Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! Pay Transparency Statement: 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. From 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, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards. The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plansubject to the terms and the conditions of the plan. HCSC Employment Statement:We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. Base Pay Range$54,800.00 - $121,100.00 | |