Company : Highmark Inc. Job Description : 

JOB SUMMARY

This job leads the planning, developing, analyzing of critical processes around the most complex benefits solutions and customer implementation activities.  Leads analysis of data and identifies risk/ issues of key processes.  Leads and participates in and/or conducts problem solving sessions.  Documents and communicates deliverables. Coaches, consults, and mentors team members, as needed, on processes and new/enhanced functionality and benefits solutions configuration activities.  Functions may include complex estimating/sizing, issue and risk management, resource management, and quality control activities. Leads and collaborates with project teams, production teams, and various internal and external constituents to ensure that established quality goals are being incorporated into the business solution and operational outcomes. Provides consistent and regular feedback to customer and process owners with recommendations for continuous improvement. Provides support and guidance in relation to the most complex processes and customer outcomes and metrics. Mentors less experienced team members.

This role is looking for someone who has ASO, TPA and Stop Loss experience.

ESSENTIAL RESPONSIBILITIES

Lead in performing quantitative and qualitative analysis of data, identification of gaps and communication of findings. Lead in supporting the most complex benefits quality control and assurance activities by developing and maintaining workflow templates and other best practice activities for the organization. Develop reports and solutions that provide project teams with critical metrics for effectively measuring and managing the most complex customer implementation deliverables and processes. Lead in establishing testing processes and guidelines for activities supported within the organization that can be leveraged across the organization. Lead, coach, consult and mentor team members.  Develop and implement process improvements and efficiencies related to the most complex benefits configuration and test activities. Lead and collaborate with project teams and external customers to ensure that established quality goals are being incorporated into the business solution. Other duties as assigned or requested.

EXPERIENCE

Required

Bachelor’s Degree in Healthcare Administration, Business, Information Science or other related field 

Substitutions

6 years of professional-level experience or equivalent combination of post-secondary education and professional-level experience in health care operations, technology delivery, or healthcare analysis/consulting (preferably with Benefits Solutions systems) accepted in lieu of degree

Preferred

None

EXPERIENCE

Required

5 years of experience working with stakeholders, support, and project teams to understand, design, and configure complex algorithms and data constructs

Preferred

5 -7 years of experience in Heath Insurance Operations, Benefits Operations, or other related field related is preferred 5 - 7 years of experience with client, product, and/or benefits configuration techniques Proficiency and/or experience with Lean principles and/or Six Sigma yellow belt is a plus Technical aptitude with 3 years of hands-on experience in programming language principles and application of programming rules, conditions, and parameters is a plus Knowledge of testing principles with 5 years of experience testing data, systems, and/or controls is a plus

LICENSES OR CERTIFICATIONS

Required

None

Preferred

None

SKILLS

Strong communication skills (verbal and written) Organization skills Presentation and facilitation skills Ability to multi-task Independent thinker and contributor Project Management experience Working in a Matrix environment Good communication skills Strong Negotiation skills Strong resource planning and management skills

Language Requirement (other than English)

None

Travel Required

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-Based

Teaches/Trains others regularly

Rarely

Travels regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (Sales employees)

Does Not Apply

Physical Work Site Required

No

Lifting: up to 10 pounds

Does Not Apply

Lifting: 10 to 25 pounds

Does Not Apply

Lifting: 25 to 50 pounds

Does Not Apply

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.

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. 

Pay Range Minimum:

$57,700.00

Pay Range Maximum:

$106,700.00

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.  The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

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 ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

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