Company :Highmark Inc.
Job Description :
This job defines, plans, implements and successfully delivers readiness and execution activities for all Federal Markets segments. Oversees and manages all activities necessary to maintain efficient business mitigation & control processes, while ensuring adherence to all applicable state and federal regulatory standards. Ensures assigned initiatives are proactively and comprehensively managed; implementing the sales, marketing and product strategies reducing the risk of non-compliance and meeting or exceeding planned revenue. Acts as the primary Business Interface for driving matrixed partner organizations across the enterprise towards strategic delivery. Promotes a risk aware culture; ensure effective risk & compliance management practices by adhering to required standards and processes. The incumbent is primarily responsible for representing all Federal Markets segments in the identification of critical market operations issues, oversight for cross functional issue resolution, resource alignment, assurance for processes or capabilities definition based on business direction, and oversight that monitoring controls are institutionalized.
- Coordinate with other senior team members on daily direction of work processes and prioritization with assigned staff monitoring as necessary to ensure accurate & timely go-to-market readiness, risk mitigation and initiative delivery. Ensure operational excellence relative to each segment's readiness and execution and related compliance activities.
- Assess risks that might jeopardize successful achievement of the desired results, develop risk mitigation strategies and tactics, and implement risk mitigation plans.
- Prioritize & resolve high impact potential problems collaboratively and effectively using strong judgment, thought leadership and critical thinking.
- Monitor and evaluate operational performance of processes (e.g., completeness, accuracy, timeliness) along the Federal Markets segments' value streams; direct corrective actions in partnership with functional owners, as needed. Report to the executive team/sponsor/steering committee on the progress, business impacts and strategies required to ensure proper performance.
- Conduct and implement lessons learned to continuously improve the readiness and execution processes, adapting to business needs.
- Participate in the development and delivery of training for staff and related departments and corporate overviews as necessary to ensure the appropriate level of knowledge to support the Federal Markets' readiness and execution processes.
- Participate in internal and external audit activities including onsite audits and reporting requests. Coordinate with senior team members on review of prosepctive policy.
- Lead and participate in the identification and justification of initiatives that drive value and differentiation of Federal Markets' products to ensure they are planned and executed successfully.
- Other duties as assigned or requested.
- Bachelor's Degree
- 6 years of related and progressive experience in lieu of Bachelor's degree
- Master's Degree
- 3 years with Strategic Initiatives Delivery, Project Management, Business Analysis, or Business Systems Analysis
- 3 years in the Health Insurance Industry
- 1 year in Audit & Compliance
- Experience in external vendor management and leading complex operational initiatives
- Experience with CHIP, Medicare, or ACA business and operating in the post Health Care Reform environment
LICENSES or CERTIFICATIONS
Project Management Professional (PMP), (Lean) Six Sigma
- Strong facilitation and cross-functional expertise
- Comfortable managing uncertainty and ambiguity
- Project Management Skills with emphasis on Risk Management
- Analytical Skills
- Business Process and Planning
- Problem Solving and Decision Making
- Strategic Mindset
- Quality Auditing
Language (Other than English):
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Teaches / trains others regularly
Travel regularly from the office to various work sites or from site-to-site
Works primarily out-of-the office selling products/services (sales employees)
Physical work site required
Lifting: up to 10 pounds
Lifting: 10 to 25 pounds
Lifting: 25 to 50 pounds
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 job 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.
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.
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 )
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