Carrier Oversight Coordinator (HCA/SHB #10118359)

$26.57 - $39.86 Hourly$55,273 - $82,909 AnnuallyThis position is a Pay Band C7Posting DetailsInterviews are anticipated to be conducted within two weeks of closing date. This job posting may be used to fill multiple vacancies. The New Mexico Health Care Authority (HCA) is a state agency that provides comprehensive, accessible, and high-quality health care services to New Mexico residents. The agency is responsible for managing key services such as Medicaid, SNAP, TANF, and LIHEAP, ensuring uninterrupted support and care for New Mexicans. Our Vision Every New Mexican has access to affordable health care coverage through a coordinated and seamless health care system. Our Mission We ensure that New Mexicans attain their highest level of health by providing whole-person, cost-effective, accessible, and high-quality health care and safety-net services. Our Goals Leverage purchasing power and partnerships to create innovative policies and models of comprehensive health care coverage that improve the health and well-being of New Mexicans and the workforce. Achieve health equity by addressing poverty, discrimination, and lack of resources, building a New Mexico where everyone thrives. Implement innovative technology and data-driven decision-making to provide unparalleled, convenient access to services and information. Build the best team in state government by supporting employees' continuous growth and wellness. Why does the job exist?The Carrier Oversight Coordinator will: Provide dedicated oversight of third-party administrators (TPA), a critical function that directly impacts member experience, benefit accuracy, and overall program integrity; Audit vendor performance, resolving complex claims and eligibility issues, and proactively identify service breakdowns; Through data-driven monitoring and collaboration with internal and external stakeholders, this role mitigates financial and operational risk, supports continuous improvement, and reduces escalations, enhancing the efficiency of customer service, compliance, and program operations; Ensure that members are receiving the highest level of service from State Health Benefits (SHB) vendors. How does it get done?The Carrier Oversight Coordinator is responsible for: Monitoring vendor performance by developing and maintaining systems to track third-party administrator (TPA) performance, monitoring key performance indicators, identify trends, flagging underperformance for leadership, and overseeing corrective actions when needed; Auditing and compliance oversight, which includes conducting targeted audits of vendor processes (such as claims, appeals, authorizations), documenting compliance issues and requesting improvements, and ensuring vendors meet contractual and regulatory standards; Resolving and escalating issues by investigate complex or high-impact cases escalated by internal teams or members, collaborating directly with vendors to resolve critical issues, and improving internal tracking and reducing future escalations; Utilizing vendor data to identify potential service failures, supports development and implementation of corrective action plans, participates in root cause analysis and process improvement initiatives, acts as liaison between vendors and internal departments, assists in preparing oversight reports and executive briefings, and shares actionable insights with leadership to support decision-making and strategy. Who are the customers? State and local government employees and their dependents who rely on State Health Benefits for their coverage needs. Ideal CandidateThe Ideal Candidate will have: Experience in vendor oversight; Excellent written and verbal communication skills; Proficiency with Microsoft Word and Excel; Commitment to high quality member services, transparency, and team work. Minimum QualificationAssociate's Degree and three (3) years of experience in program administration or project management in areas related to the purpose of the position. Any combination of education and/or direct experience in this occupation totaling five (5) years may substitute for the required education and experience. Employment RequirementsMust possess and maintain a valid Driver's License.Must obtain a Defensive Driving Certificate. Working ConditionsWork is performed in an office setting, exposure to Visual/Video Display terminal (VDT), and extensive personal computer and phone usage. Supplemental InformationDo you know what Total Compensation is? Click here Agency Contact Information: Ashtyn Lopez, (505) 695-8977. Email For information on Statutory Requirements for this position, click the Classification Description link on the job advertisement. Bargaining Unit PositionThis position is not covered by a collective bargaining agreement.

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