Job Posting Title
Research and Resolution Specialist
Agency
807 HEALTH CARE AUTHORITY
Supervisory Organization
EGID
Job Posting End Date
Refer to the date listed at the top of this posting, if available. Continuous if date is blank.
Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above.
Estimated Appointment End Date (Continuous if Blank)
Full/Part-Time
Full time
Job Type
Regular
Compensation
$25.432692 / hourly
Why You'll Love Working Here
At the Oklahoma Health Care Authority (OHCA), your work matters. Every day, our team helps ensure Oklahomans have access to better health and better care. Guided by our core values, Passion for Purpose, Trust & Transparency, Empowerment & Accountability, Best-in-Class, Outcome-Driven, and Servant Leadership, we foster a workplace where people feel supported, respected, and empowered to make an impact. Learn more about OHCA.
Let's Talk Benefits
We know your great work deserves great support. Here's a snapshot of what we offer for all eligible employees.
Generous state-paid benefit allowance to offset insurance premiums.
A wide selection of insurance plans with no pre-existing condition exclusions.
Flexible Spending Accounts for health care and dependent care.
Retirement Savings Plan with employer contributions.
11 paid holidays annually.
15 days of vacation and 15 days of sick leave in the first year.
Longevity Bonus recognizing years of public service.
Public Service Loan Forgiveness eligibility and tuition reimbursement.
Wellness benefits, including an on-site gym and fitness center discounts.
Job Description
Location: 4345 N Lincoln Blvd, Oklahoma City, OK 73105
Salary: $25.432692 / hourly
Work Schedule: Monday - Friday
Primary Hours: 8:00 a.m. - 5:00 p.m.
Agency/Division Information
The Oklahoma Health Care Authority (OHCA) works to ensure Oklahomans have access to better health and better care. The agency's core values include passion for purpose, trust and transparency, empowerment and accountability, best in class and outcome-driven, and servant leadership. As part of the interview process, candidates may be required to attend an in-person interview at our Oklahoma City office.
Position Purpose
The Research & Resolution Specialist is responsible for accurately processing forms, referrals, reports, and special projects, ensuring compliance with CMS PDP Guidance, EGID Rules and Regulations, and HIPM regulations. The role requires effective communication, problem-solving skills, and the ability to prioritize and manage various tasks to maintain the accuracy and efficiency of operations.
Essential Functions May Include:
Process all enrollment, change, and termination forms within five working days, maintaining established ranges of accuracy and productivity.
Protect privacy and confidentiality of program participants' information and comply with HIPM regulations.
Correctly process Medicare changes and notifications, as well as eligibility updates from Third Parties, within accuracy ranges and required time constraints, in compliance with current Center for Medicare & Medicaid Services (CMS) Part D Program (PDP) Guidance, EGID rules and regulations and all unit procedures.
Handle urgent and non-urgent member and dependent eligibility and premium accounting referrals within accuracy ranges and required time constraints, adhering to all unit procedures and EGID rules and regulations.
Review and process reports, queries, and other tasks, ensuring compliance with CMS PDP Guidance, EGID Rules and Regulations, and Unit and Member Accounts procedures.
Create and mail letters regarding Active, Pre-Medicare and Medicare enrollments, changes, disenrollments, cancellations or changes within the required accuracy ranges and adhering to all CMS PDP guidance, federal guidelines and EGID rules.
Complete special projects as assigned. Respond accurately to inquiries within established timeframes.
Attend recurring unit/department/division/agency meetings and any mandatory trainings provided by Member Accounts leadership or Human Resources.
Other duties as assigned.
Knowledge, Skills, Abilities and Competency Requirements
This position requires knowledge of CMS Part D Program guidance, EGID rules and regulations, HIPAA privacy requirements, and other applicable state and federal compliance standards related to eligibility and benefits administration. The employee must be skilled in accurately processing forms, reports, referrals, queries, and eligibility updates within established timeframes and accuracy expectations. This role requires the ability to organize and prioritize daily, weekly, and monthly workload, maintain high productivity, identify and resolve discrepancies, use tracking systems to meet required deadlines, and communicate clearly and professionally with internal and external customers. The employee must also protect confidential information, collaborate with others to resolve issues, and demonstrate the Korn Ferry competencies of Ensures Accountability, Action Oriented, and Communicates Effectively.
To be considered for this position your application must include a resume/CV with complete work and education history.
Education and/or Experience:
OR
Preference Qualifications Include:
A bachelor's degree.
2 years for experience in bookkeeping work, insurance eligibility determination or closely related work.
2 years of experience in the maintenance, analysis and reconciliation of insurance or benefits accounts.
Physical Demands and Work Environment
Work is typically performed in an office setting with climate-controlled settings and exposure to moderate noise levels. In the course of performing job duties, employees are required to speak, stand, walk, and reach with their hands and arms. This position requires extended periods of sitting and daily use of computers and phones. Employees must be willing to complete all job-related travel associated with this position. Being present at the office is an essential function of this position.
Accommodation Statement
The Oklahoma Health Care Authority complies with applicable State and Federal civil rights laws and does not discriminate. All qualified applicants will receive consideration for employment without regard to race, color, sex, religion, disability, age, national origin, or genetic information. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact the Civil Rights Coordinator at 405-522-7335.
Notice to applicants:
Please add OHCAHR@okhca.org to the address book or "safe-senders" list in your email. All correspondence will come from this address. Be sure to check your junk folder. If you have questions about the status of your application, you can contact the HR team at 405-522-7093.
Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above.
Current State of Oklahoma employees must apply for open positions internally through Workday Jobs Hub.
Equal Opportunity Employment
The State of Oklahoma is an equal opportunity employer and does not discriminate on the basis of genetic information, race, religion, color, sex, age, national origin, or disability.
Current active State of Oklahoma employees must apply for open positions internally through the Workday Jobs Hub.
If you are needing any extra assistance or have any questions relating to a job you have applied for, please click the link below and find the agency for which you applied for additional information:
Agency Contact