Director, Health Care Services

Director, Health Care Services

The State Teachers Retirement System of Ohio (STRS Ohio) is seeking a Director, Health Care Services to join its Member Benefits/ Health Care General Administration team.

Established in 1920 and serving Ohio's educators, STRS Ohio is one of the nation's largest retirement systems, serving over 500,000 active, inactive, and retired public-school teachers, and university faculty members, managing approximately $96.9 billion as of June 30, 2024, in assets and paying more than $7 billion in benefits annually.

STRS Ohio provides a competitive pay, and a comprehensive benefits package including on-site parking, educational assistance, subsidized medical insurance, fully paid dental and life insurance, vacation and sick leave, retirement benefits and on-site fitness center. At STRS Ohio, you can experience rewarding work in a professional, business casual work environment. We welcome, celebrate, and promote respect for everyone. We are continually seeking bright and talented individuals to join our team.

Compensation: $158,704 or commensurate with education and experience

Work Schedule: 8:00am-5:00pm Monday through Friday (Onsite)

General Summary: Under the direction of the deputy executive director chief benefits officer, Member Benefits, provide strategic leadership and operational oversight of operations, compliance, claims management, and payer relationships for the State Teachers Retirement System of Ohio's (STRS Ohio) retiree health care (Medicare and non-Medicare) program. This includes the oversight and management of the health care department that promotes enrollees receiving the maximum value from the program within the funding limitations of the system.

Summary of Responsibilities:

• Develop and implement a strategic health care plan that meets the State Teachers Retirement Board's directives, policies and funding limitations in conjunction with the deputy executive director, member benefits and the health care management team.
• Provide strategic input on plan design, risk management and regulatory reporting.
• Oversee the development and monitoring of the health care services budget.
• Oversee the coordination of management for the associate health care programs in conjunction with the human resources department.
• Oversee the development and review of communications regarding the health care program. Confer with other departments throughout the organization.
• Ensure compliance with all federal, state and industry-specific regulations including Center for Medicare & Medicaid Services (CMS), Affordable Care Act (ACA), Employee Retirement Income Security Act of 1974 (ERISA) and Health Insurance Portability and Accountability Act (HIPAA).
• Emphasize and promote professional, ethical conduct.
• Research and recommend appropriate amendments to STRS Ohio governing laws and board rules, as appropriate.
• Develop and maintain effective working relationship with key stakeholders.
• Maintain working knowledge of health care environment through reading, professional conference attendance and professional contacts. Oversee, monitor and evaluate effects of external events affecting STRS Ohio, state and national health care plans.
• Respond with urgency and compassion to escalated member issues.
• Implement special projects as directed by the deputy executive director, member benefits.

Summary of Qualifications:

• Bachelor's degree in health administration, business, finance or related field required.
• Master's degree strongly preferred.
• Ten or more years of progressive leadership experience in medical insurance, managed care or health plan administration required.
• Extensive knowledge of health care plan design, function, administration and funding required.
• Strong understanding of medical and prescription contractual terms, payer contracting and regulatory compliance. Knowledge of federal and state insurance regulations, including CMS guidelines and commercial insurance rules.
• Ability to handle the following:
• Apply advanced mathematical concepts and understanding generally accepted accounting and finance principles.
• Read, analyze and interpret healthcare related scientific and technical journals, health care reports, financial reports, legal documents and contracts.
• Proficiency in data analytics and performance reporting tools.
• Implement ideas and plans to improve health care services.
• Think and plan strategically.
• Respond to complex inquiries or complaints from regulatory agencies and members.
• Ability to work with and preserve confidential information required.
• Superior oral and written communication skills with the ability to make presentations to groups in a clear, accurate, and interesting manner and to work effectively in a team effort.
• Interpersonal skills necessary to deal effectively and courteously with internal and external contacts required.

Equal Employment Opportunity Employer Statement: State Teachers Retirement System of Ohio (STRS) is an Equal Employment Opportunity Employer and prohibits discrimination and harassment of applicants or employees on the basis of race, color, religion, gender, gender identity or expression, national origin (ancestry), military status, disability, age, genetic information, sexual orientation, or caregiver status, in making employment-related decisions about an individual.

ADA Statement: STRS Ohio is committed to ensuring access, inclusion, and reasonable accommodations across all its services, activities, programs, and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.