Log In
Sign Up
Job Description
Job Summary
Reports directly to the CSG Administrator and Health Plan Administrator and provides financial direction and reporting for the health plan operations. Manage day-to-day operations of the Health Plan Finance Department and the Membership Accounting Services Department. Maximize the return on financial assets through the establishment of financial policies, procedures, controls and reporting systems. Ensure legal and regulatory compliance for all accounting and financial reporting functions within the health plan. Areas of responsibility include financial reporting and analysis (internal and external) and budgeting and analysis in relation with Corporate and FHP Finance.
I. Essential Duties and Responsibilities
1. Finance
1.1. Designs, develops and implements strategic, process improvement and operating financial systems, financial budgeting and planning systems, financial policies and controls to ensure integrity and establish creditability and consistency in managing and reporting financial data, both historic and prospective.
1.2. Conducts assessments on continuing basis and identifies areas for improving financial controls, and key revenue and cost indicator information to improve general business decision-making, budgeting, and long-term strategic planning processes. Provides timely information, suggestions, and advice to the Health Plan Administrator in the resolution of various general business problems and decisions, and in attaining short-term and long-term profitability goals and return on investment.
1.3. Designs, develops and implements short and long-term financial planning tools and reports to provide management with comprehensive financial translation of business strategies and the effect of the various alternative strategies.
1.4. Ensures that all responsible department heads are in full compliance with all financial reporting requirements. Develops and maintains all reports by departmental management to ensure accurate and timely reporting of all required financial parameters.
1.5. Designs and develops management reports, modifies and/or replaces systems, internal controls, to enhance the integrity and value of information provided to the Health Plan Administrator.
1.6. Ensures timely and accurate financial reporting and management for the health plan including but not limited to financial closing, billing and collection, account receivable management and budget management.
1.7. Ensure timely and accurate reporting of Medical Loss Ratio to Federal, Government of Guam and National Association of Insurance Commissioner (“NAIC”).
2. Membership Accounting Services
2.1. Provides oversight to the enrollment and eligibility transactions by ensuring that the processes of receiving, logging, screening, verifying and coding of data for inputting into the Facets
database using department policies, procedures and guidelines as well as group/individual policy contracts are accurately performed and in a timely manner.
2.2. Ensures accurate encoding and approval of enrollment requests, premium payments and fact sheets into the Facets database.
2.3. Ensures compliance to Corporate and Health Plan account receivable management policies and procedures and achievement of established goals and objective around account receivables.
2.4. Performs aging analysis and review of revenue and eligibility reports to resolve any account receivable issues and enrollment discrepancies.
2.5. Designs, develops and implements strategic, process improvement and operating systems on enrollment and eligibility functions including auditing.
3. Internal Audit
3.1. Develops plans and programs in order to implement the timely and efficient conduct of internal audit functions such as test of internal controls, compliance to policies and procedures and accuracy of data reporting, to ensure that appropriate recommendations are made to improve internal controls.
3.2. Coordinates with the External Auditor for any audit engagement needs and ensures that audit requirements are met on a timely and efficient manner.
3.3. Evaluate alternatives to Health Plan Finance and MAS Department operations and makes recommendations to the Health Plan Administrator and Controller concerning ways of reducing operating costs, increasing revenues and enhancing the efficiency of operations.
3.4. Reviews and analyzes the financial statements of the health plan and affiliates to identify variances and ensure that they are prepared accurately and in accordance with Generally
Accepted Accounting Principles.
3.5. Ensures compliance with federal, state and local requirements by researching existing and new legislation, consulting with outside advisors and filing financial reports as required. Advises the Health Plan Administrator of actions and potential risks.
4. General Management
4.1. Planning
4.1.1.1. Develops strategic plans and programs for finance and ensures that goals and objectives of the team are properly defined and clearly established.
4.1.1.2. Develops policies, guidelines, and implementing procedures and ensures consistent company-wide implementation.
4.1.1.3. Ensures that operating expenses are well within the prescribed limits of budget plans and fiscal guidelines.
4.1.1.4. Keeps Controller and Health Plan Administrator apprised of significant issues, problems and progress to facilitate administrative and strategic decision making.
4.2. Organizing
4.2.1.1. Designs and develops the appropriate organization structure for the Health Plan Finance and MAS function.
4.2.1.2. Delineates, defines, and streamlines its various functional activities, thereby ensure its effectiveness in maximizing the utilization of both asset and people resources.
4.3. Leading
4.3.1. Performs selection and staffing functions such as:
4.3.1.1.1. In collaboration with Human Resources Department, conducts in-depth assessment interviews to determine the technical and behavioral competencies of the candidate to ensure that the best from among the qualified candidates are being hired in the company.
4.3.1.1.2. Adheres to, and implements the philosophy of “hiring the best fit” and ensures that prospective employees’ personal values are aligned with the company’s corporate values.
4.3.2. Conducts regular and periodic meetings with the team, to ensure the following:
4.3.2.1.1. Implementation of all financial plans, programs, and projects are strictly adhering to prescribed deadlines and schedules.
4.3.2.1.2. All communications and relevant information pertaining to the team are cascaded to the proper channels within the team in particular, and the organization in general.
4.3.3. Conducts and implements “Performance Improvement Program”, through the following:
4.3.3.1.1. Performance coaching for the staff who failed to perform and deliver the prescribed and committed level of performance output and standards.
4.3.3.1.2. Performance counseling staff with behavioral/attitudinal problems. Implements the necessary guidelines on discipline management for erring
employees, in accordance with company policies, rules and regulations, due process, and government regulations.
4.3.3.1.3. Performance mentoring for high potential staff, capable of assuming bigger responsibilities in the future.
4.3.4. Performs training and development functions, as follows:
4.3.4.1.1. Designs and develops training programs that are relevant and necessary for the continuous development of the technical competencies of the team.
4.3.4.1.2. Recommends and implements for appropriate training programs that will further enhance and hone the technical competencies of the staff.
4.3.4.1.3. Conducts training programs, and acts as subject matter expert on training programs pertaining to Health Plan Finance, MAS and Controllership.
4.4. Controlling
4.4.1.1. Develops and formulates performance measures and standards for the team, as basis for the conduct of annual performance management review program.
4.4.1.2. Reviews and evaluates the performance of the team, on regular and periodic basis, and ensures that the overall performance of the team is on-track, and well within the
pre-established goals and objectives.
4.4.1.3. Consolidates performance status reports of the team as basis for monitoring the weekly progress of the various activities within the team.
II. Experience & Specifications
1. Education:
1.1. Bachelor’s Degree in Accounting or Finance; Licensure and/or Certification Required: CPA
2. Experience:
2.1. Minimum of 5 years of broad experience in accounting and finance preferably gained from health insurance or related industry.
2.2. Very strong experience in financial management, financial planning and analysis, financial policies and investor relations and financial reporting. Knowledge of federal and state tax laws and requirements.
2.3. Working knowledge of accounting systems software appropriate to healthcare or related industry.
3. Behavioral Competencies:
3.1. Demonstrate strong negotiation, influencing and analytical skills.
3.2. Strong ethics and a high level of personal and professional integrity.
3.3. Leads inspirationally, nurtures commitment to company’s vision and shared values.
3.4. Tactfully mitigate conflict and performance development issues in a demeanor that promotes behavioral change.
3.5. The ability to handle a demanding workload, yet meet positional and company objectives under pressure.
3.6. Strong analytical skills and adept in interpreting strategic vision into an operational model.
3.7. Results and accountability driven, with a track record to prove it.
3.8. Ability to fully engage employees, capture their loyalty and extend their capabilities.
3.9. Accepts accountability for actions and decisions. Wiliness to self-correct, change and grow.Job Type: Full-time
