The job is a client-facing role directing the pre and post-sale operations support and project management activities associated with the partnership and insourced business that is hosted on the company's core operating platform using either an ASP (platform only) or BPO (platform and personnel) insourced model. The solutions architected and proposed will vary in size and consist of large national employers, segments of a health plan's business (ie, direct pay, small group, Medicare Advantage), and/or the entire book of business of a health plan. Will also orchestrate internal processes and initiatives within the division to drive process standardization and singular, streamlined business processes; drives standardization of process between the operational tiers within division for all operational functions; manages process, organizational and cultural issues which pose high visibility and risk; and develops strategies and plans in support of numerous processing arrangements requiring coordination across multiple locations.
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.
Leads client-facing delivery implementation of large multi-year relationships with clients. Leads the operational due diligence and planning efforts in the sales cycle and ongoing, provides performance and capability presentations, and builds relationships with key leadership and personnel from other health plans, employers, BCBSA, CMS and other prospective customers. Responsible for tracking inventory, forecasting needs based on trending.
Directs the gathering of client-specific requirements, managing all components of the solution design (eg, operational, system, process and human), architecting methods of integrating the client's existing systems and data (if applicable), development of the project and implementation plan(s), estimating costs (implementation and run) and various other scoping and implementation activities. Build and maintains operational expertise with clients and key internal teams. Responsible for direct relationship with customers and ongoing relationship management, including oversight of metrics and service level agreements (SLAs), to continue successful delivery of the agreement. Reviews the necessary follow-up post implementation on execution and course correction to SLA. Recommends process improvements. Responsible for managing the P&L financials and performance as well as operational effectiveness of the functions and services.
Other duties as assigned or requested.
Bachelors Degree- Business, IT, Healthcare or other related area
6 years of relevant work experience in lieu of a Bachelor's Degree
Masters Degree - Business, IT, Healthcare or other related area
10 years of experience with insurance products principles, industry practices, operational and system processes, quality control techniques, resource management and financial management
10 years of experience evaluating technology for implementation in gaining improved services as well as re-engineering of process and procedures to keep administrative costs down
5 years of management experience working with or architecting solutions to complex operational systems, systems design, technology architecture or production
5 years of experience of insurance product knowledge with an understanding of BC plans or commercial insurers
5 years of experience in workforce development and resource management
3 years of experience with project management
KNOWLEDGE, SKILLS & ABILITIES
Ability to build and sustain internal and customer relationships
Solid negotiation and influencing skills across sales, technical, and operations partners
Excellent written and verbal communications skills; ability to interact and communicate with all levels
Proficient in the use of MS Word, Excel, and PowerPoint
Demonstrated ability in financial management of engagements and/or large organizational units
50 - 75%
PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS
Most On-The-Road Positions
An employee in this position may work in a home or company office environment but is also frequently driving to and from various locations to perform the work off-site. The position frequently requires the employee to communicate effectively with others both inside and outside the workplace (eg, in person, via telephone, via email). The employee must be able to understand, interpret and analyze data, solve problems, concentrate, and research, use available technological resources and systems (eg, computers and computer programs), multi-task, prioritize, and meet multiple deadlines to complete essential tasks. The employee generally works in a fast-paced and frequently stressful environment, must attend work on a regular and reliable basis as well as adhere to all workplace policies, and may be called upon to work outside regular business hours.
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies
Referral Level Payout 3
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, 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, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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.