Job Description :
This job is responsible for end to end process oversight. The incumbent monitors timeliness of active cases/claims in the system via work in process (WIP) reports, and triage cases at or near meeting regulatory deadlines and business standards as appropriate. This requires working across multiple areas of the Health Plan and HM Solutions, and across teams within the department. Implements, monitors, and meets daily, weekly, monthly, and annual performance targets. Monitors trends and partners with Workforce Management and leadership to ensure adequate staffing to support volume and partners with leadership to develop performance metrics around throughout and accuracy at a department and individual contributor level.
- Oversight of end to end process. Work with leaders across the Health Plan, HM Health Solutions, and the department to ensure there are no breaks in process that could impact compliance to regulatory requirements, business standards, and/or service level agreements. This includes working with Health Plan vendors. Identify bottlenecks and work effectively with leaders in those areas on the appropriate resolutions.
- Monitor volume via work in process (WIP) reports,. Appropriately triage to ensure timeliness of completion. This may involve working across multiple leaders and/or engaging a staff member regarding a potential delay. Partner with leaders and Workforce Management to ensure adequate staffing levels.
- Prepare contingency plans for potential outages. Implement, educate, and maintain contingency plans as processes and systems evolve.
- Create, implement, monitor, and meet daily, weekly, monthly, and annual performance targets and performance metrics for departments and individual staff members (in partnership with leaders).
- Partner with leaders and Workforce Management to ensure adequate staffing levels.
- Other duties as assigned.
- Bachelor's Degree in Business Administration/Management, Supply Chain Management, Industrial Engineering or Health Administration
- 6 years of experience in a Process Oversight or Production Management role
- 3 – 5 years of Process Design experience
- 3 -5 years of Process Improvement experience
- 1 -3 years of Claims experience
- 1 -3 years of Healthcare Industry experience
- 1 -3 years of Reporting experience
LICENSES OR CERTIFICATIONS
- Statistical Analysis and Measurement
- Process Development & Oversight
- Process Optimization
- Operational Planning
- General Computer Skills
- Highly Organized
- Written & Oral Presentation Skills
- Healthcare Industry
Language Requirements (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 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.
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