Job Details

This job establishes overall strategic, financial, and tactical business and operational direction for the assigned areas. Functions as the business owner for all customer implementation and maintenance for all group and individual product business across all partner plans, inclusive of benefit project efforts and relevant technology support. Accountable for high quality customer satisfaction and outcomes across multiple health plans. Involved and engaged in proactive identification and resolution of customer contract issues. Accountable for the financial performance and service responsiveness related to benefit application and client administration. Accountable for the identification of enhancements and expanded capabilities of major enterprise systems supporting client implementation. Accountable for the implementation of and adherence to government regulations, corporate policy mandates, corrective action plans, and process improvement initiatives. Partners and works collaboratively with all related and matrixed areas across the Enterprise.

ESSENTIAL RESPONSIBILITIES

• Performs management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management, and staff productivity.
• Plans, organizes, staffs, directs, and controls the day-to-day operations of the department; develops and implements policies and programs as necessary; may have budgetary responsibility and authority.
• Directs end-to-end customer implementation operations with accountability for customer satisfaction, financial performance, proactive risk identification, issue resolution, process excellence, and quality control. Continually identifies and implements strategic initiatives to improve and streamline operational capabilities and processes.
• Leverages automation, analytics metrics, and operational excellence to manage overall financial performance and drive customer satisfaction.
• Optimizes workforce mix and manages workforce development, capacity, and retention.
• Facilitates development of strategic and tactical solutions to diverse and complex business problems.
• Creates divisional and corporate strategic and tactical plans to grow the platform and the business.
• Develops and manages vendor relationships and contracts.
• Communicates effectively with all levels of the organization as well as developing reports and presentations and representing customer implementation to executive leadership, regulatory bodies, external customers, external auditors, and other parties as necessary.
• Other duties as assigned or requested.

EDUCATION

Required:

• Bachelor's Degree - Business, Health Administration, or related field or relevant experience and/or education as determined by the company in lieu of bachelor's degree

Preferred:

• Master's Degree - Business, Health Administration, or related field

EXPERIENCE

• 5 years of management experience
• 7 years of experience in benefit operations, insurance industry, and/or other relevant experience to include experience in implementing and running new operational units and business process improvement

KNOWLEDGE, SKILLS & ABILITIES

• Leadership skills and ability to relate to all levels of management and staff, as well as external customers and vendors
• Proven ability to develop and negotiate vendor relationships and contracts
• Knowledge of processes and procedures re-engineering and strong knowledge of change management
• Strong business acumen with knowledge of financing and/or budgeting
• Ability to evaluate technology for implementation and gaining improved services
• Strong written and oral communication skills
• Excellent leadership development, team building, and professional development skills

LICENSURE & CERTIFICATIONS

Required:

• None

Preferred:

• None

TRAVEL REQUIREMENT:

0% - 25%

PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS

Position Type:

Office-Based

Teaches / Trains others regularly: Frequently

Travels regularly from the office to various work sites or from site-to-site: Does Not Apply

Works primarily out-of-the office selling products/services (Sales employees): Does Not Apply

Physical Work Site Required: True

Lifting:

up to 10 pounds: Does Not Apply

Lifting:

10 to 25 pounds: Does Not Apply

Lifting:

25 to 50 pounds: Does Not Apply

ADDITIONAL INFORMATION

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity, or any other category protected by applicable federal, state, or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status, or disability.

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity

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