Company :Highmark Inc.
Job Description :
The Core Manager of Operations and Audit support Large Group, Small Group, and Individual business segments. This team is still transitioning from a solely operations team to a dual-purpose team of operations and audits. Even though it is not a comprehensive list, below are some primary responsibilities of the team. The Audit function will be responsible for supporting any external audits from institutions like the PA Insurance Department, supporting internal Highmark audits like MAR, and managing/executing Underwriting’s proactive audits like Large Group multi-year contract reviews, Small Group UW Guideline reviews, and National client process reviews. The Operations function will be responsible for some of the logistics of Underwriting such as reviewing the new business Small Group sold cases before implementation of the group, triaging all medical health questionnaires for our medically underwritten Large Group new business quotes, beginning the renewal process by preparing the Large Group renewal folders with applicable documentation, and loading/verifying that renewal rates were successfully loaded into Highmark data warehouses.
- Behave in a manner that exhibits the company’s core values. Support, interpret, and promote adherence to departmental and company goals, strategies, policies, procedures and norms. Manage and develop employees by setting clear, concise performance expectations, monitoring progress, providing constructive feedback and creating an environment that encourages ongoing growth. Complete performance planning and evaluations in a timely manner. Manage own activities and others to accomplish assigned goals and objectives within agreed upon time constraints. Develop sound strategies that create a line of sight from individual to department to company goals and objectives.
- Reviews renewal and prospect quotes to provide guidance as to whether results are reasonable and appropriate.Recommend modifications to situations that will result in adverse selection and subsequent financial loss.
- Demonstrate an expert understanding of the contents and intent of corporate risk management policies. Identify critical information needs in risk management negotiations and modify arrangements based on the information available. Discuss alternative risk management and pricing methods in use by others in the industry and provide advantages and disadvantages to each method.
- Oversee production to ensure timely and accurate completion of renewals and prospect quotes.
- Develop relationships with decision makers based on trust and credibility to enhance influence on risk management and pricing decisions. Provide solid and persuasive arguments to move Sales and external audiences toward appropriate risk solutions. Enhance department influence by negotiating workable solutions, meeting deadlines and providing responsive service.
- Lead departmental efforts in areas such as, but not limited to, pricing policy, departmental policies and procedures, product development, interdepartmental processes or corporate projects. Oversee departmental tools and processes such as, but not limited to, training, testing, reporting and process improvement. Support all audit and market conduct reviews in order to maintain compliant rates, controls and processes.
- Other duties as assigned or requested.
- Bachelor Degree in Mathematics, Actuarial Science, Finance, Business, Computer Science, Nursing, Healthcare Administration or other quantitative analysis discipline
- 6 years of related experience
- 8 years of experience in underwriting or actuarial
- 12 years of experience in underwriting
- Producer’s License in Accident and Health or a willingness to pursue and obtain a Producer’s License within six months
- Possesses or is willing to obtain within two years, a professional designation related to the health care industry (i.e. HIAA/AMHC, CEBS, SOA) or a Licensed Registered Nurse without restriction
- Ongoing compliance with all requirements to keep all licenses and professional designations
- Expert understanding of the contents and intent of corporate risk management policies
- Skilled and knowledgeable interaction with various internal departments and external stakeholders
- Ability to work independently and assume responsibility for staff and complex projects
- Ethical business practices with adherence to all privacy and confidentiality policies and regulations
- Proven leadership skills – ability to motivate others to quickly achieve results in a matrixed environment
- Knowledge of industry and market trends to develop and champion long-term strategies
- Ability to effectively persuade others to listen, commit, and act on a new approach
- Self-confident with an ability to accept and respond to challenges in a positive manner
- Strong and effective verbal and written communication skills
- Effectively presents complex topics in a concise manner to audiences at various levels and in various sizes
- Broad understanding of business issues, metrics, organizational linkages and customer value
- Successful experience in achieving results through people in a complex environment
- Strong organizational and analytical skills in addition to project leadership and management skills
SCOPE OF RESPONSIBILITY
Does this role supervise/manage other employees?
Is Travel Required?
Yes, but it is rare
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:$92,300.00
Pay Range Maximum:$170,800.00
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
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