At the University of California, Berkeley, we are committed to creating a community that fosters equity of experience and opportunity, and ensures that students, faculty, and staff of all backgrounds feel safe, welcome and included. Our culture of openness, freedom and belonging make it a special place for students, faculty and staff.
The University of California, Berkeley, is one of the world's leading institutions of higher education, distinguished by its combination of internationally recognized academic and research excellence; the transformative opportunity it provides to a large and diverse student body; its public mission and commitment to equity and social justice; and its roots in the California experience, animated by such values as innovation, questioning the status quo, and respect for the environment and nature. Since its founding in 1868, Berkeley has fueled a perpetual renaissance, generating unparalleled intellectual, economic and social value in California, the United States and the world.
We are looking for equity-minded applicants who represent the full diversity of California and who demonstrate a sensitivity to and understanding of the diverse academic, socioeconomic, cultural, disability, gender identity, sexual orientation, and ethnic backgrounds present in our community. When you join the team at Berkeley, you can expect to be part of an inclusive, innovative and equity-focused community that approaches higher education as a matter of social justice that requires broad collaboration among faculty, staff, students and community partners. In deciding whether to apply for a position at Berkeley, you are strongly encouraged to consider whether your values align with our Guiding Values and Principles, our Principles of Community, and our Strategic Plan.
As a national collegiate leader, University Health Services (UHS) is a comprehensive campus-based health center providing fully accredited medical and mental health care, education, a major medical insurance plan, and innovative health promotion programs for students, faculty and staff. UHS is deeply committed to ensuring affordable, well-integrated, multidisciplinary healthcare that effectively supports the university's diverse campus communities, through equitable access and culturally competent, high-quality programs and services.Learn more at http://uhs.berkeley.edu
Health Insurance Administration:This position manages the provision of employee and student health insurance services at University Health Services. Major areas of responsibility include operationalizing the UHS infrastructure to accommodate major UC Berkeley employee and student insurance plans; third-party billing (excluding Medicare/Medi-Cal); and management of the Berkeley Student Health Insurance Plan. Attentive monitoring of insurance services financial and operational performance. Direct planning, development, implementation, measurement and evaluation of service provision to multiple insurance plans. Work with plan carriers and systems to improve the operational productivity, support client centered services, and maintain fiscal goals.
Key Responsibilities include:
I. Berkeley Student Health Insurance Plan Direct overall management of the Berkeley Student Health Insurance Plan (SHIP), a fully insured major medical, mental health, dental and vision plan for 23,000 UC Berkeley students with claims experience of approximately $70M annually as of 2020. 1. Manages the Student Health Insurance Office including development, direction and implementation of a wide variety of work assignments, ensuring appropriate staffing levels through fluctuating workloads and development of effective policies and procedures. Oversight of eligibility, billing, case management and customer service:
Managing eligibility and enrollment in SHIP for UC Berkeley students and affiliated groups
Providing benefits counseling to clients and processing authorizations for care covered by the plan
Revise, review and approve annual benefit booklet and SHIP brochure to reflect plan changes for the new plan year. Ensures SHIP website is updated appropriately whenever changes occur.
Coordinating health insurance programs for specialized university groups such as Intercollegiate Athletics and Visiting Scholars Program.
Assisting students with dental and vision coverage provided through SHIP by major dental and vision carriers
2. Manages the plan's relationships with external business partners (Medical, Dental, Vision and UHS Brokerage) 3. Chair the SHIP operations team. Conducts long-range financial planning and utilization analysis for the health plan. Oversight and analysis of Plan claims experience and preparation of reports for SHIP executive management team (SHIP Operations Team) 4. Maintains strong relationships with UC Berkeley Student Government, UC Office of the President, Berkeley SHIP Student Advisory Committee, and UCB Student Advocates Office, Visiting Scholars' Program, and InterCollegiate Athletics. Provides oversight of the IA insurance program claims management and coordination of benefits with SHIP 5. Models excellent customer service skills for all internal and external clients and campus stakeholders.
II. Service provision to non-SHIP insurance plans. 1. Work with insurance carriers, UC Employee Benefits, brokers et al. to establish in-network contractual agreements for UHS as a medical and mental health service provider. 2. Manage implementation projects in collaboration with UHS colleagues in clinical administration, clinical services, information technology, etc. to implement reasonable ramp-up. 3. Develop metrics and evaluation frameworks to assess and report out on mix of service provision every six months. 4. Researches and summarizes best practices in the field. Acts as subject matter expert to SHIO and UHS staff on the interpretation of major medical insurance plan contracts, affordable care act (ACA) enrollment eligibility, benefit utilization and billing and reimbursement procedures. 5. Monitors and performs Medical, Dental and Vision plan pre- and post-contracts work, interpreting regulations and guidelines on contracts, ensuring expenses are paid according to contract (premiums, premium true up for appropriate payment to carriers based on agreed to enrollment numbers) 6. Models excellent customer service skills for all internal and external clients and campus stakeholders.
III. Health Plan Case Management, Project Management and Consultation 1. Supervises, guide and mentor insurance case coordinator who is responsible for supervising 4 customer service representatives and resolving complex claims issues, coordination of benefits, eligibility issues and case management of patients with sensitive or complex needs.
Ensures complex cases requiring high-level case management and customer service are handled with timeliness, sensitivity and within parameters of the health plan. Works directly with all levels of UHs staff, plan members, member's parents, providers and insurance brokers to determine the most appropriate resolution of the issue. Consult with Medical Director on especially complex cases.
Negotiates provider relations director of fully insured medical plan to establish special contracts/single case agreements for unique cases requiring treatment that would not be otherwise available.
Annual and adhoc presentation of SHIP benefits and plan changes to parents of incoming freshmen, UHS clinicians, Community Mental Health Providers, CalDay etc.
IV. Staff Development 1. Works collaboratively with team to ensure consistently strong customer service is provided in all encounters 2. Develops and executes strategy to support team members in working to the top of their job descriptions.
4-5 years insurance health plan design and management experience
Comprehensive experience with federal and state laws regarding patient privacy and security.
Knowledge of financial analysis and reporting techniques, human resources policies and procedures for staff and represented employees.
Strong, demonstrable skills in short and long term strategic planning, critical thinking, analytical skills, creative problem solving, and project management.
Demonstrated ability to establish and maintain effective working relationships with all levels across campus, outside vendors and administrators.
Demonstrated initiative and resourcefulness.
Facilitation: Demonstrated ability to facilitate teams and committees effectively; develop interpersonal relationships that contribute to workplace effectiveness in a diverse environment.
Advanced interpersonal communication skills to include verbal and written, active listening, critical thinking, persuasiveness, advising and counseling skills.
Bachelor's degree in related area and/or equivalent experience/training
3-5 years supervisory experience in a labor environment
Student health insurance plan management experience.
Knowledge of medical coding systems (CPT, ICD-9, HCPCS, etc)
Knowledge of common University -specific computer application programs.
Knowledge of University rules and regulations, policies, processes, protocols and procedures for budget, account and fund management, personnel management.
Knowledge of the HIPAA Privacy Rule and California state laws regulating privacy and confidentiality of health information.
Salary & Benefits
Hiring Range: $83,900 - $124,200 annual. Salary commensurate with experience. Includes full eligibility to UC benefits plan. For information on the comprehensive benefits package offered by the University visit:
Please submit your cover letter and resume as a single attachment when applying.
Employment is contingent on successful completion of: Background Check, Acceptable Medical Evaluation that includes infectious disease surveillance and proof of current required vaccinations or immunity levels, and successful credentials verification (if applicable).
Conviction History Background
This is a designated position requiring fingerprinting and a background check due to the nature of the job responsibilities. Berkeley does hire people with conviction histories and reviews information received in the context of the job responsibilities. The University reserves the right to make employment contingent upon successful completion of the background check.
Equal Employment Opportunity
The University of California is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. For more information about your rights as an applicant see:
The University of California was chartered in 1868 and its flagship campus - envisioned as a "City of Learning" - was established at Berkeley, on San Francisco Bay. Today the world's premier public university and a wellspring of innovation, UC Berkeley occupies a 1,232 acre campus with a sylvan 178-acre central core. From this home its academic community makes key contributions to the economic and social well-being of the Bay Area, California, and the nation.