Company :Highmark Inc.
Job Description :
This position responsible for the implementation, execution and successful migration of Highmark’s TPA business. This includes but is not limited to the successful creation and execution of the Project Plan required to merge multiple TPA’s into one fully functional TPA. Ultimately accountable for the profitability and membership of the corporation’s TPA business. This includes the development and execution of the mission, vision, strategic objectives, strategies, critical success factors and strategic initiatives that support Highmark’s corporate objectives related to national business. This job provides strategic leadership in the development of short- and long-range objectives, policies, budgets, and operating plans for the TPA business. To assure stability, direction/vision, achieve growth and attain segment and Enterprise goals. Establishes the management structure, defines the culture, and provides overall leadership and direction by which the organization operates. Is accountable for the overall performance and results of the organization as well as management and control of the affairs and property of the TPA division.
This job provides strategic leadership in the development of short and long-range objectives, policies, budgets, and operating plans for Highmark’s TPA Solutions. To assure stability, direction/vision, achieve growth and attain segment and Enterprise goals. Establishes the management structure, defines the culture, and provides overall leadership and direction by which the organization operates. Is accountable for the overall performance and results of the organization as well as management and control of the affairs and property of the TPA division
- Work with external partners (TPA’s, Sales, Brokers, and Consultants) to deliver a viable and sustainable TPA business unit.
- Lead Internal teams and Business Partners (ex. - Mphasis, Javelina, Trustmakr, etc) to complete project activities and deliverables on time and on budget.
- Define the TPA strategy and roadmap. Oversees the affiliation life cycle/implementation and ongoing support requirements.
- Further develop the pricing and staffing model needed in order to ensure the business’ ongoing success.
- Ensure all TPA operations are in compliance with BCBS Association requirements and state and federal regulations.
- Introduce and market new products/services by developing time-integrated plans with internal and external partners.
- Accountable that the appropriate mix of products, services and solutions are available to serve the TPA market.
- Responsible to develop an ongoing approach that will grow share in the market.
- Serve as the point of contact for all TPA issues for resolution.
- Work with internal business partners in evaluating third party partnerships and additional growth opportunities.
- Lead the development of an operation reporting structure and a health dash board that encompasses the success and failures of the operations.
Strategic Planning Execution:
1. Lead the implementation of financial and operational strategy
2. Communication of strategy to management
3. Lead the development and implementation of sales, financial, operational and marketing strategies to respond to market conditions and demands.
4. Review relevant financial information and make relevant adjustments.
5. Create and execute on growth and potential acquisition strategies
6. Financial Operations Oversight
7. Approval of financial reporting including monthly reports to COO
8. Respond to all significant trends regarding sales, membership, vendors, commissions, product performance, expense variances and other revenue fluctuations.
9. Lead the development of the annual budget.
Lead the development and implementation of technology and process improvements to reduce administrative costs, make it easier for customers to do business with HNAS and enhance capabilities to continue to grow in the respective markets.
Lead a highly effective team:
1. Lead an organization that deploys managerial and other staff resources effectively.
2. Provide developmental and growth opportunities for direct reports
3. Provide regular coaching and feedback to direct reports
4. Ensure a collaborative senior management work team that is focused on achieving business goals in a preferred work environment
- Other duties as assigned
- 10 years of experience in Health Insurance Sales Management, Health Plan Operations, Provider Contracting or TPA Services.
- 7 years of management experience
- Demonstrate qualities of leadership, analysis, administrative ability, and communication skills. Ability to plan, initiate, direct, and carry out short and long-term priorities.
- Ability to communicate effectively both orally and in writing is a must.
- Bachelor's Degree in Business, Healthcare Administration or a related field OR Extensive management level experience in the private or public sector with background in business and/or health management.
- Extensive management level experience in the private sector with background in business and/or health management.
LICENSES or CERTIFICATIONS
Language (Other than English):
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Office- or Remote-based
Teaches / trains others
Travel 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.
Pay Range Minimum:$198,900.00
Pay Range Maximum:$377,800.00
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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