Mgr Customer Operations (Individual Market & Pharmacy) (Finance)

Job Description:

Summary:

Under the guidance of Customer Operations Senior Leadership, the position is responsible for managing assigned area and ensuring that departmental metrics are met and assigned projects completed accurately and on time on a consistent basis. The position will manage the activities of assigned areas such as Customer Operations Accuracy and Training, Workforce Planning, and Operational Improvement. Responsible for creating and managing business plans consistent with the Health Plan strategic goals. Develops staff through coaching and mentoring and ensures training needs are met so that the related claims and customer care expectations, corporate goals, BCBSA performance standards, and federal and state mandate objectives are achieved.

Essential Primary Responsibilities/Accountabilities:

• Directs, manages, and evaluates all activities associated with specific areas in Customer Operations.
• Instructs or otherwise acts as a resource for Supervisors, Systems and Process Experts, and Analysts in dealing with special or unique Challenges.
• Responsible for meeting assigned timeframes, maintaining best practices, and ensuring integrity of assigned deliverables.
• Keeps abreast of problems or unique situations encountered, takes accountability for and coordinates resolution efforts and notifies Customer Operations leadership or other affected areas of management as needed.
• Maintains expertise in technology and procedures to make the best use of available resources through planning, organization, system development and modification, as well as effective and economical utilization of personnel and equipment.
• Ensures consistent policies and procedures are in place and adhered to in all regions.
• Ensures that unit practices comply with federal and state laws and corporate personnel policies.
• Ensures the effective utilization of material resources by administering budgets and maintaining operational costs within corporate guidelines.
• Prepares reports and makes detailed presentations to project teams, project sponsors, department heads, and all levels of management regarding project status and communicates plans for resolution for those that are exceeding timeframes.
• Administers the review, monitoring, and management of numerous critical reports including, but not limited to inventory, prompt pay, performance guarantee, MTM and IPP. Oversees the coordination by appropriate regional management to ensure necessary action is taken to resolve.
• Directs and manages team to focus on trend identification, root cause analysis and problem-solving necessary to accurately and efficiently resolve customer inquiries in an organized manner, resulting in superior accuracy and production levels, retention of subscriber contracts and escalation prevention.
• Directs the development of process improvements ensuring the use of methodologies and principles that align with corporate goals to conduct process modernization projects, identifying best end to end practices.
• Represents Customer Operations across the Health Plan internally and externally to ensure all internal and external customer needs are met.
• Oversees the coordination by appropriate regional management to ensure necessary action is taken to resolve issues.
• Plans, develops, implements, trains, and manages Customer Operations Initiatives through implementation and post-implementation audit to ensure optimum service is provided to all customers while meeting the accuracy and timeliness measurements critical to corporate success.
• Leads the implementation of Customer Operations focused Health Plan-wide initiatives and coordinates the activities with all other departments within the corporation and externally.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values and adhering to the Corporate Code of Conduct.
• Models the Lifetime Way behaviors and values on a consistent basis and promotes these behaviors to the division. This includes focusing on leadership development to ensure we are hiring, developing and retaining leaders to deliver operational excellence.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are in compliance with these requirements.
• Conducts periodic staff meetings to include timely distribution and education related to departmental and Ethics/Compliance information.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.
• Customer Operations Operational Improvement Specific:
• Supports Workforce Planning, Processing Accuracy, Claims Processing and Customer Care Teams through identification and implementation of technical solutions.
• Validates post implementation system fixes through production validation testing.
• Oversees preparation and submission of technical service requests.
• Acts as a technical resource for Customer Operations support teams in the creation of procedural documentation, coordination of training programs and execution of systems and process initiatives and projects.
• Performs analytical and systems functions which support the Customer Operations Teams with inventory reduction, inquiry and processing accuracy and efficiency.
• Researches and analyzes complex Customer Operations system issues to determine root cause and prepares plans for remediation.
• Explores opportunities, offers proposed recommendations, and assists in the implementation of Operational Process Automation.  
• Customer Operations Processing Accuracy and Service Quality Specific:
• Ensures all accuracy data collection, including audits, inspections, adjustments, and any other data from Customer Operations analytical tools are appropriate and monitored.
• Provides meaningful accuracy scores for Customer Operations staff and incorporates those scores with other relevant performance feedback.
• Identifies areas that are at high risk for error and coordinates the implementation of corrective and preventative processes and procedures.
• Recommends and assists in the development and implementation of quality plans for the accurate processing of claims pends, adjustments and Customer Care inquiries across all areas in Customer Operations and in other operational areas across the Health Plan.
• Customer Operations Learning and Performance Specific:
• Owns the strategic planning and deployment of Training Delivery programs and associated activities to ensure internal and external customer satisfaction. Ensures continual assessments of training need, development of seminars, training programs and courses, coordination of training of trainers, and evaluation of the effectiveness of training.
• Manages a cross regional team of Trainers, responsible for meeting Training curriculum timeframes, maintaining training delivery best practices to include Adult Learning principles, and ensuring integrity of Training classroom preparation.
• Ensures Training is compliant with all relevant legislative and regulatory mandates and ensures that all activities meet these requirements, including member privacy.
• Provides feedback to Operations management relevant to trainee progress and solicits feedback via focus group and training surveys for continual improvement in training design and delivery.

Minimum Qualifications:

• Bachelor's degree and a minimum of five (5) years of experience in an operations environment, two (2) of which must be in a defined leadership role. In lieu of degree, minimum of nine (9) years progressive experience in an operations environment. Demonstrated knowledge and experience in the overall health care industry is a plus.
• Familiarity with health care systems, practices, and procedures preferred.
• Ability to establish effective relationships with other areas of the corporation and Blues Plans.
• Demonstrated leadership skills.
• Demonstrated skills in forming and fostering high performing, cross functional teams.
• Excellent written and oral communication skills, adaptable for all levels of management.
• Demonstrated conflict resolution skills.
• Proficient at identifying root causes of business and/or workflow problems and determining innovative solutions and opportunities.
• Ability to organize, prioritize, and manage multiple initiatives with effective and accurate results.
• Ability to translate business needs and processes into clear and concise procedural documentation.
• A working knowledge of Microsoft Office applications is required.

Physical Requirements:

• Work is completed in a traditional office environment under fluorescent lighting.
• Ability to arrive on time at work and as scheduled.
• Ability to meet minimum performance metrics.
• Ability to orally communicate.
• Must be able to function while sitting at a desk viewing a computer and using a keyboard and mouse for 3 or more hours at a time.
• Must be able to travel across the enterprise.

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The Lifetime Healthcare Companies aims to attract the best talent from diverse socioeconomic, cultural and experiential backgrounds, to diversify our workforce and best reflect the communities we serve.

Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture. We believe that diversity of thought and background drives innovation which enables us to provide leading-edge healthcare insurance and services. With that mission in mind, we recruit the best candidates from all communities, to diversify and strengthen our workforce.

OUR COMPANY CULTURE:

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s):

Grade E6: Minimum: $79,068 - Maximum: $142,322

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.