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PHC is an equal opportunity employer and does not discriminate in the hiring, training, or promotion of employees by reason of race, color, religion, sex or nation origin. We offer full benefit packages including medical/dental/life insurance and 401K.

Preferred Health Care (PHC), a local PPO, is building a dynamic team of managed care professionals. If you are looking for a rewarding and challenging position here in the Lancaster community, the following opportunities are available at PHC:

Risk Specialist in TPA Services

Preferred Health Care (PHC), a local PPO, is building a dynamic team of managed care professionals. If you are looking for a rewarding and challenging position here in the Lancaster community, the following opportunity is available at PHC:

Risk Specialist
PHC is currently seeking a full-time Risk Specialist in TPA Services. Qualified candidates will have a Bachelors degree and a minimum of three years working with health plan stop loss in a TPA or stop loss carrier office. The candidate must have strong interpersonal skills required to negotiate stop loss contracts and build partnerships.

The ideal candidate is able to work independently, manage multiple tasks to meet deadlines, use Microsoft Office Suite applications, and have experience with claim administration software and reporting. He\she will be able to speak effectively and professionally. Position requires frequent interaction with clients, brokers, carriers and vendor partners of the TPA. He/she will be responsible for building and maintaining strong business relationships. We offer competitive pay and benefit package upon experience. Office hours are Monday through Friday 8 AM to 4:30 PM. To be considered interested candidates must submit their resume and salary requirements to:

Human Resources
Preferred Health Care
PO Box 4824
Lancaster, PA 17604
Fax: 717-560-2312
email: resumes@phcunity.com



Claims/Customer Service Manager

Preferred Health Care (PHC), a local PPO, is building a dynamic team of managed care professionals. If you are looking for a rewarding and challenging position here in the Lancaster community, the following opportunity is available at PHC:

The Claims/Customer Service Manager is responsible for the day to day oversight of the Claims/Customer Service Departments. The position will work with VP of Operations to identify and implement short and long range goals, supervision of claims/customer services staff, enhancement of claims business development efforts and a continuous focus on optimization in the areas of compliance, quality and reporting. The Manager is responsible for creating and ensuring compliance with company policies, procedures, State and Federal regulatory requirements for all claims operations under their management. This Manager will identify opportunities for innovation and operationalization of new ideas.

RESPONSIBILITIES:

  • Develops, implements, and continually assesses service improvement initiatives including policies and procedures based on current and future trends.
  • Develops performance standards for departmental operation, evaluates actual performance against standards, and implements action plans for improvement.
  • Manages the compliance of the Claims operation with regulatory and accrediting agencies, including but not limited to claims payment timeliness, payment accuracy, and performance guarantee (PG) standards for specific clients with PG metrics.
  • Responsible for the recruitment, training, management and development of claims/customer service staff including auditing staff performance.
  • Creates and promotes a high-performance culture of service, innovation and results.
  • Oversees training and policy development goals and provides oversight to ensure the goals and program are aligned with departments operation goals.
  • Responds to and manages internal or external Corrective Action Plans (CAP).
  • Collaborates with other management staff to ensure that policies, procedures and workflow revisions are consistent across the company.
  • Provides coordination of external audits, regulatory reviews, and legal case reviews involving the Customer Service operations as they relate to Claims operations.
  • Assists in preparation of annual department budgets.
  • Completes and oversees special projects assigned by leadership.
  • Performs other duties as assigned for which the employee is qualified to perform.
  • The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

COMPETENCIES AND SKILLS:

  • Demonstrates leadership skills with ability to work collaboratively to produce results across functional teams.
  • Demonstrates ability to develop and execute action plans to meet goals and objectives.
  • Demonstrates competence in written, oral, electronic communication skills, and effective time management.
  • Communication (verbal, written and listening), managerial, interpersonal, organizational, time management, negotiation/sales, problem solving, leadership skills
  • Proficiency with Microsoft Office 8 or higher.

EDUCATION AND/OR EXPERIENCE:
Bachelor's Degree in Business, Health Care Administration or a related field plus 5 years Claims Managerial experience required. Office hours are Monday through Friday 8 AM to 4:30 PM. We offer competitive pay and benefit package. To be considered interested candidates must submit their resume and salary requirements to:

Human Resources
Preferred Health Care
PO Box 4824
Lancaster, PA 17604
Fax: 717-560-2312
email: resumes@phcunity.com

FREQUENTLY ASKED QUESTIONS

How do I apply for a position? You can apply electronically by submitting your cover letter and resume to resumes@phcunity.com. You can fax your cover letter and resume to us at 717-560-2312 or you can mail your resume to the address above.

If I submit a resume for an open position, will I be considered for other opportunities? You will be considered for the specific position for which you applied. If you are interested in applying for additional or future positions, you will need to submit a new resume for each position.

Can you tell me the salary range for the position I'm interested in? Each position is graded according to skill level and education required and has a salary range attached to the grade. Salary discussion is part of the applicant interview process.

What happens when I submit my resume? Will I be notified that it has been received? When your resume is received, it will be reviewed in respect to the job for which you applied. Selected applicants will be invited for an interview.

Disclaimer / Privacy Policy
Preferred Health Care
Urban Place • 480 New Holland Ave, Suite #7203 • Lancaster, PA 17602
Phone: 717-560-9290 • Fax: 717-560-2312 • Email: info@phcunity.com