Consultant Ext Partnerships - WC08BE

AD Ext Partnerships - WC07AE

We're determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here means having every opportunity to achieve your goals - and to help others accomplish theirs, too. Join our team as we help shape the future.

The External Partnership Team has a uniquely designed business model which supports The Hartford's partnership with our third-party administrators/vendors, ensuring the adherence to applicable compliance regulations, agreements, and business rules.

We oversee the end-to-end processes outsourced to these administrators, while juggling multiple priorities, often competing time commitments and diverse project loads.

• Own primary accountability for building effective working relationship with a select number of assigned clients, TPAs and/or vendors.
• Effectively monitors the TPAs daily operations, services and compliance to ensure procedures / functions are in accordance with The Hartford's contracts and business practices.
• Supporting external partnerships as the lead in identifying and resolving daily internal and external service and operation inquiries/activities; involves effectively assessing customer concerns/needs, business needs and networking with appropriate resources to provide creative solutions.
• Effectively work with cross-functional teams and resources to achieve desired business objectives with assigned TPA and/or vendor while concurrently managing ongoing/daily operational expectations and deliverables.
• Design/implement effective audit programs as required by regulations and enterprise best practices.
• Ability to answer routine and non-routine questions and resolve/manage issues across all functional concerns, with a focus on balancing risk management and operational objectives; includes GB functions as well as other corporate concerns (e.g. SSRE, THIP, BRO, legal, compliance, etc.)
• Coordinate verbal and written communications and business priorities with assigned clients and proactively identify opportunities, improvement possibilities and practices for optimal outcomes. Ability to summarize information and make recommendations.
• Works with external partners on compliance with State Department of Insurance mandates, policies and procedures and relationship management.
• Works with external partners and The Hartford Complaint Team to appropriately respond to all escalated complaints, such as DOI, Social Media, Consumer Affairs, Executive, Legal, etc. timely and gather all pertinent information for legal review.
• Works in tandem with the Product team to successfully implement new product designs and spear-heading the TPA development and execution of building the programs to support The Hartford's products.
• Provide training for internal and external partners as needed.
• Participate in project work as requested.
• Works independently under minimum supervision and support from manager.
• Ensure proper implementation and claims adjudication of Group Benefit contracts with business partners to optimize Group Benefit claims results to best position our claims and operational capabilities for competitive and profitable growth.
• Delivers and leads TPA messaging of The Hartford business decisions and strategies.
• Act as expert claims resource to interpret and communicate Policy language to ensure accurate claims adjudication with TPAs. Primary point of contact on Group Benefit claims for policy/contract interpretation and eligibility, compliance, pricing, process and financial Issues.
• Applies basic knowledge through advanced learning.
• Appropriately handles moderately complex issues, investigates, displays expertise, and provides solution options.
• Foundational knowledge of product/service offering and related business processes.
• Strong understanding of legal contracts and inherent business risks
• Acting as a change agent, embracing new procedures, processes and guidelines; and steering the changes across the appropriate internal & external partners
• Ownership for final audit reports and related discussions/action plans to remedy issues; including negotiation of action plans where needed
• Manage all communications with TPA and/or vendor for evolving corporate requirements after identifying options and assessing related implementation risks (for HIG & client)
• Proactively offer insights to client for improved business practices/processes based on boarder market learnings & opportunities
• Traveling up to 25% to complete on site TPA and/or vendor audits is required

• B.S./B.A. degree or relevant work experience
• 2+ years work experience in a business or insurance environment working with Third Party Administrators or vendors preferred.
• Minimum of two years of Claim Audit experience and strong knowledge of medical claim coding preferred.
• Candidate must be well organized, have strong interpersonal skills and self-disciplined with ability to work independently to carry out result communications and resolutions
• Strong technical skills with a command of Excel and Word programs required, knowledge of Visio a plus.
• Working knowledge of basic accounting principles
• Strong demonstrated negotiation skills
• Exceptional teamwork and collaboration skills; able to work successfully across multiple cross-functional areas to influence outcomes and drive results.
• Strong verbal and written communication skills