Our many years in the insurance industry have shown us that each company has its own distinct structure, so it can be difficult to know exactly what it means to work in a particular department. The following summaries will help you learn more about the operations of PacificSource and its subsidiaries.
To learn more about a specific department, please click on the department link below:
Actuarial, Underwriting, and Analytics
This department is made up of three distinct teams. Actuarial Services is responsible for pricing development, rate filings, reserving, and premium and claims projections. Underwriting is responsible for calculation of group specific rates and medical underwriting. Data Analytics is responsible for reporting and analysis in support of employer reporting, medical management, and plan performance.
Across our companies, this department processes medical, dental, vision, flexible saving, and dependant daycare claims. Claims are processed both electronically and manually.
COBRA legislation requires employers who offer group health insurance to provide a way for employees who leave their company to continue health benefits. Handling the compliance components and billing former employees for the cost of their coverage can be very time-consuming and confusing for employers. In the Manley COBRA Department, we literally take over all the necessary paperwork, notifications, billing, and personal contact required to make the transition into COBRA compliance.
The main focus for this department is on corporate and marketing communications. This includes writing, editing, and formatting to ensure accurate, clear, professional communications. The Communication staff members are also involved in advertising, public relations, promotions of events, sponsorships, and other marketing opportunities.
For all of our companies, the Customer Service Department provides live phone service, with no automated prompts. Customer Service Representatives provide courteous, accurate and prompt phone service to all customers. Customer contact is mainly over the phone, but also includes walk-ins and e-mails.
In addition to some of the standard accounting functions such as accounts payable, accounts receivable, and payroll our Finance Department has a broader reach through an internal auditing function, which helps management address risk areas and improve operations while achieving our strategic goals.
Staff in this department help ensure that members get appropriate care and support members who have healthcare needs. This is done by reviewing preauthorization and referral requests and providing utilization review of hospitalized members and case management. Additional responsibilities include coordinating wellness and disease management programs, managing the pharmacy benefit, and providing coordination of care and case management for inpatient and residential chemical dependency and mental health treatment.
Almost anything related to personnel, from the day someone applies for a job until they leave the company, is handled by the Human Resources Department. Major functions include recruiting, new employee orientation, benefit administration, learning and development, and compensation.
The focus for the Individual Department is on educating people about the health insurance system and individual coverage in general. They work with individuals not covered through an employer group plan to provide policies and answer questions.
This department has broad responsibilities for the technology used by our companies including computers, software, networks, servers, databases, the web, and the security of each of these.
Legal and Compliance
This department is our "go to" resource for understanding legal and compliance issues as they pertain to PacificSource's health insurance policies, business contracts, and other legal relationships.
Marketing and Sales
Employees in the Marketing and Sales Department build relationships with agents, plan administrators, and members by providing personal service. Responsibilities include conducting benefit meetings, processing new groups or renewals, and researching and developing new products.
This department is called something slightly different across our companies, but the function they serve is the same. Responsibilities include providing dedicated service to the group administrator and members by processing payments, answering billing questions, and adding or removing members to group plans.
The main function of Production Support is to deliver companywide solutions in support of new and existing business processes, as well as increase business process efficiency and reduce administrative costs as these relate to our core software application.
This team maintains partnerships with hospitals, provider associations, physicians, and practitioners. Responsibilities vary throughout the department and include verifying providers’ licensing, visiting provider offices, assisting with billing or claim issues, educating providers on current billing practices, and hosting workshops.