Company :Highmark Health
Job Description :
This job leads the decision making responsibility for multiple programs as it relates to performance from a financial, operational, procedural, compliance, and market delivery perspective. Oversees and implements product management and development strategies, objectives and initiatives and ensures product activities are in alignment with enterprise vision and strategy. The job oversees initiatives involving internal and external constituents (e.g. vendors, IDN, provider, regulators) as necessary to ensure successful delivery of new products and programs. Directly responsible for overseeing the professional staff responsibilities, activities and coordination across the enterprise; responsible for providing leadership and direction to matrix staff across the enterprise including business and technical teams for the purpose of program/product initiative implementation. Ensures compliance with federal and state regulations pertaining to ACA, Medicaid or other portfolios. Collaborates on metrics and then reviews product/program performance results and identifies potential new market deliver opportunities. Will facilitate benefit contract development, and maintenance to support benefit designs demanded in the market. Responsible for oversight of implementation of federal, state, and BCBSA mandates. Oversees the management aspect of tools such as eMaterials that feeds corporate repository of benefits for products available to sell in the market place for all standard individual, small and large group commercial products. Oversee filing requirements/deadlines related to healthcare reform products. Oversee portfolios are accurately entered into Medicaid, CMS Marketplace exchanges, private exchanges or other customer-facing portals.
- Perform 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.
- Plan, organize, staff, direct, and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
- Identify, develop, and manage the implementation of innovative product/program offerings and variations that align with the Enterprise corporate strategic and business goals to meet customer needs, grow and maintain market share while ensuring product effectiveness, efficiency and maintaining product integrity. Create and maintain strategic initiative business case, vision documents, business requirement, project work plans, and tracking of all implementations.
- Manage all phases of the preparation and management of work/action plans by the department’s professional team to provide effective oversight to the total product development lifecycle from product concept, product development, product implementation and product maintenance.
- Ensure the development of a high-performing team, including cross-functional collaboration with matrixed business partners to deliver needed results.
- Responsible for compliance with all federal and state requirements for full suite of portfolio solutions. Ensure products adhere to HIP standards, and all filing requirements/deadlines are met. Assure accuracy of product portfolio on the Medicaid or CMS Marketplace exchanges, private exchanges and other customer-facing portals.
- Oversee all materials (product description documents, benefit booklets, contracts, subscription agreements, sales support materials, communications/publications, web materials, etc.) to ensure that these documents support existing product specifications and reflect the current product offering, administration and/or the modifications resulting from new initiatives.
- Ensure that products and programs are monitored and maintained in accordance with product contracts, product policies, rules and federal and state regulations. Respond to inquiries and benefit exception requests from the respective markets.
- Facilitate collaboration and cooperation across multiple departments and functional areas as required to ensure that the product development lifecycle activity is completed according to the work plan including but not limited to enrollment, membership, id cards, benefits, claims, sales force, provider repository, billing, web portals, EOBs, marketing systems.
- Other duties as assigned or requested.
- Bachelor's Degree in Business, Marketing, Healthcare Administration or other related area.
- Master's Degree in Business, Marketing, Healthcare Administration, or other related area
- 7 years of practical experience in healthcare, insurance and/or product management and development required
- Experience in leading large scale strategic initiatives and/or process improvement/ technology initiatives to address business challenges
- Strong analytic background (ability to assess business processes; product performance; etc.)
- Clinical, network, or reimbursement experience
LICENSES & CERTIFICATIONS
KNOWLEDGE, SKILLS & ABILITIES
- Thorough knowledge and understanding of healthcare, insurance, general healthcare financing, strategic planning, provider contracting and reimbursement, and product marketing. This includes both group and individual products
- Practical experience in applying marketing and product principles such as pricing, demographic and target marketing and competitor analysis
- Experience in operational improvement initiatives and improvement
- Extensive knowledge of health insurance operations, systems and applications (such as claims / membership systems, benefits)
- Ability to apply analytical frameworks to unstructured business problems
- Ability to lead without formal authority
- Strong verbal and written skis
- Knowledge of healthcare industry trends and challenges
0% - 25%
Language Requirement (other than English)
PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS
Teaches/Trains others regularly
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
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 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.
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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