Job ID: J116457
Company: Highmark Inc
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Feb 8, 2018
The Director will orchestrate internal processes and initiatives with the division to stabilize core operational reporting infrastructure with the goal of driving process standardization, performance measurement and shaping of organizational culture around business process optimization and singular, streamlined business processes. The incumbent drives standardization of reporting processes between the operational verticals, manages process, organizational and cultural issues which pose high visibility and risk, and develops strategies and plans in support of numerous processing arrangements requiring coordination across matrix functions and stakeholder groups. The incumbent also has global oversight of the creation and maintenance and root cause analysis of documented quality processes, controls and testing for all divisional functions.
Essential Job Functions:
1. Accountable for the overall strategy, design, development and implementation of extraction/transformation/load (ETL) technology components, logical and physical data models, data quality technology components, metadata management content and technology components, technical architecture solutions and data rationalization and standardization processes and procedures to enhance customer business operations performance and effectiveness.
2. Directs the internal technical and quality support staff within division directly supporting / enabling the operational tiers to meet or exceed established performance expectations.
3. Responsible for the overall development and ongoing refinement of predictive analytic models and general analytics to improve overall management of client management, member management, customer service, claims processing, and billing processes.
4. Accountable for directing a Health Services operational analytic and decision support function responsible for complex data analysis and projects related to operations integration of different types of data, (i.e., call center detail, pending claims, service inquiries, benefits, membership, billing history, financial and organization hierarchy); hypothesis-driven issues, unique and non-recurring studies; design, evaluation and development of computer-based modeling and simulations; and development of process and/or data changes to accomplish goals and objectives.
5. Provide significant input and direction to the development and evolution of company’s key operational system capabilities by investigating and recommending new processes and techniques for existing systems. Increase the usage of self-service reporting and analysis throughout health plan operations.
6. Ensure high quality staff is hired for the team. Provide coaching, mentoring and leadership to assigned staff.
7. Direct the global oversight of the creation and maintenance of documented quality processes, controls and testing for divisional functions and operations (including claims, customer service, enrollment & billing, government business, and benefit coding) necessary to support internal and external audits.
8. Communicate effectively. Display effective communication skills with all levels of the organization peer, senior and executive management.
Knowledge, Skills & Abilities:
Referral Award Level: 4
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