Manager Ops (Job Number:11417)
Description
Summary:
This position is responsible for managing and planning the activities associated with one of the following Operations departments: Claims, the Contact Center, Membership, Benefit Management or the Incoming Service Center, including performance management, auditing, managing to a budget/P&L, and handling escalated issues. Additional responsibilities include interacting and coordinating with other functions at Blue Cross within and outside of Operations; Project management and implementation responsibilities; participating in and representing the Operations division in company initiatives The Manager is responsible for implementing department specific strategies to enhance customer/member experience and improve operational effectiveness. This position will develop and lead cross-functional Benefit Development and Implementation work teams which will include collaboration with, but not limited to, Sales, Product Management, Underwriting.
Accountabilities:
1. Manages a department and team(s) within Operations and is responsible for timely and accurate processing of department specific metrics and goals according to internal, Association, regulatory and customer requirements; metrics and goals include MTM, IPP Scorecard, FEP Scorecard, Performance Guarantees, Prompt pay, budget, and other goals
2. Assesses department issues and recommends solutions; collaborates with other areas to implement process improvements; plans, develops and implements process improvement, department initiatives and objectives, cost containment programs and effective work flows and procedures
3. Manages the department including interviewing and hiring employees following required EEO and Affirmative Action guidelines, company policy and ensuring employees receive the proper training. Conducts performance evaluation, and is responsible for managing employees, including skill and career development, policy administration, coaching on performance management and behavior, employee relations and cost control
4. Establishes, monitors and communicates overall departmental performance information (metrics, inventory, complaints, etc.) and ensures adherence to performance standards; cross train staff and develop department policies and procedures/training materials
5. Manages the interpretation, implementation and communication of benefit plans; assesses the technical aspects of system interfaces; initiates and coordinates changes
6. Resolves complex and sensitive internal and external customer issues that require management intervention, and/or effective coordination with other departments, Blue plans or external partners
7. Effectively navigate Operations department specific systems as appropriate; analyze and summarize results of projects, as well as develop weekly reporting of team activities and workloads
8. Maintain compliance with contractual guidelines for hearings, claims, disputes, recoveries, etc; review performance data to monitor achievement and overall effectiveness and make business decisions that are financially responsible and justifiable
9. Create and foster a workplace culture that is consistent with the overall organization’s and that emphasizes the principles and values of the organization 10. Maintains business relationships with clients and customers and establishes strong working relationships throughout the organization; leads or participates in internal work-groups to represent the consumer perspective and facilitate change to business workflows and technology
11. Assesses the department and audit infrastructure by providing analysis, recommendations and business requirements to ensure efficient implementation of functional and systematic changes; coordinates the installation of changes with IS and other business partners (internal & external)
12. Collaborate with I.S., Sales, Product Management and Operation teams to determine business requirements and solutions; maintain strong working relationships with other BCBSMN departments including Contracts, Underwriting, I.S., Claims, Customer Service, and Product Management
Qualifications
Required Qualifications:
- Bachelor’s degree and 5 years of related experience or 9 years related experience in lieu of a degree
- 5 years experience in healthcare, insurance or other service industry
- 3 years supervisory experience
- Demonstrated ability to lead and manage projects
- Demonstrated ability to coach and develop others
- Strong analytical, problem solving, decision making and critical thinking skills and ability to use sound judgment in resolving complex issues.
- Advanced interpersonal skills, communication skills (verbal, written & listening), facilitation and presentation skills
- Experience with technology based solutions
- Intermediate experience with the MicroSoft Office Suite products
- Must have managed at least 5 direct reports from a previous or current role
Preferred Qualifications:
- Experience in a Claims, Contact Center, Membership, Benefits Management and/or Incoming Service Center leadership and management role
BlueCross BlueShield of MN is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. BlueCross BlueShield of MN is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.
Primary Location: United States-Minnesota-Eagan
Shift: Day Job
Description
Summary:
This position is responsible for managing and planning the activities associated with one of the following Operations departments: Claims, the Contact Center, Membership, Benefit Management or the Incoming Service Center, including performance management, auditing, managing to a budget/P&L, and handling escalated issues. Additional responsibilities include interacting and coordinating with other functions at Blue Cross within and outside of Operations; Project management and implementation responsibilities; participating in and representing the Operations division in company initiatives The Manager is responsible for implementing department specific strategies to enhance customer/member experience and improve operational effectiveness. This position will develop and lead cross-functional Benefit Development and Implementation work teams which will include collaboration with, but not limited to, Sales, Product Management, Underwriting.
Accountabilities:
1. Manages a department and team(s) within Operations and is responsible for timely and accurate processing of department specific metrics and goals according to internal, Association, regulatory and customer requirements; metrics and goals include MTM, IPP Scorecard, FEP Scorecard, Performance Guarantees, Prompt pay, budget, and other goals
2. Assesses department issues and recommends solutions; collaborates with other areas to implement process improvements; plans, develops and implements process improvement, department initiatives and objectives, cost containment programs and effective work flows and procedures
3. Manages the department including interviewing and hiring employees following required EEO and Affirmative Action guidelines, company policy and ensuring employees receive the proper training. Conducts performance evaluation, and is responsible for managing employees, including skill and career development, policy administration, coaching on performance management and behavior, employee relations and cost control
4. Establishes, monitors and communicates overall departmental performance information (metrics, inventory, complaints, etc.) and ensures adherence to performance standards; cross train staff and develop department policies and procedures/training materials
5. Manages the interpretation, implementation and communication of benefit plans; assesses the technical aspects of system interfaces; initiates and coordinates changes
6. Resolves complex and sensitive internal and external customer issues that require management intervention, and/or effective coordination with other departments, Blue plans or external partners
7. Effectively navigate Operations department specific systems as appropriate; analyze and summarize results of projects, as well as develop weekly reporting of team activities and workloads
8. Maintain compliance with contractual guidelines for hearings, claims, disputes, recoveries, etc; review performance data to monitor achievement and overall effectiveness and make business decisions that are financially responsible and justifiable
9. Create and foster a workplace culture that is consistent with the overall organization’s and that emphasizes the principles and values of the organization 10. Maintains business relationships with clients and customers and establishes strong working relationships throughout the organization; leads or participates in internal work-groups to represent the consumer perspective and facilitate change to business workflows and technology
11. Assesses the department and audit infrastructure by providing analysis, recommendations and business requirements to ensure efficient implementation of functional and systematic changes; coordinates the installation of changes with IS and other business partners (internal & external)
12. Collaborate with I.S., Sales, Product Management and Operation teams to determine business requirements and solutions; maintain strong working relationships with other BCBSMN departments including Contracts, Underwriting, I.S., Claims, Customer Service, and Product Management
Qualifications
Required Qualifications:
- Bachelor’s degree and 5 years of related experience or 9 years related experience in lieu of a degree
- 5 years experience in healthcare, insurance or other service industry
- 3 years supervisory experience
- Demonstrated ability to lead and manage projects
- Demonstrated ability to coach and develop others
- Strong analytical, problem solving, decision making and critical thinking skills and ability to use sound judgment in resolving complex issues.
- Advanced interpersonal skills, communication skills (verbal, written & listening), facilitation and presentation skills
- Experience with technology based solutions
- Intermediate experience with the MicroSoft Office Suite products
- Must have managed at least 5 direct reports from a previous or current role
Preferred Qualifications:
- Experience in a Claims, Contact Center, Membership, Benefits Management and/or Incoming Service Center leadership and management role
BlueCross BlueShield of MN is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. BlueCross BlueShield of MN is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.
Primary Location: United States-Minnesota-Eagan
Shift: Day Job