This job establishes and continuously improves the strategic relationship between Health Plan Operations and the markets. The incumbent supports the strategic development, evaluation, planning, and execution of key market initiatives. Proactively engages their market stakeholders to ensure alignment and awareness of market-impacting operational trends, and new or changing service offerings. The incumbent partners with stakeholders to identify solutions that may include recommendations to improve service efficiencies, or modifications to the existing service catalog.
- Partner with market stakeholders to gain an understanding of market strategies (e.g. product, GTM/sales, operational improvement) to support the efficient and coordinated execution of those strategies within HPO.
- Execute operational impact assessment for market leaders regarding new market strategies, new accounts, and account renewals. Help drive the effort to align external market strategies with HPO business goals and objectives in order to articulate clear business strategies within Operations. Serve as subject matter expert (resource) to market stakeholders on Operational functions and processes.
- Engage regularly with the Market Ops Strategic Performance Management team and connect with Operations functions as appropriate to ensure resolutions are standardized. Maintain strong relationships with external markets to ensure smooth and effective resolution of requests. Identify patterns and problem areas in order to recommend, and where able, implement effective solutions to increase Operational efficiency. Manage communications to external stakeholders related to progress of initiatives, incidents and services solutions.
- Define strategic KPI’s and analyze reports to ensure KPI’s are being met or exceeded and market requests/issues are fully vetted and/or resolved. Ensure appropriate analysis of critical and escalated market-impacting operational business incidents to determine causation, impact, and suggested resolution. Contribute to the development of standards and processes for management of operational incidents.
- Lead the stream of activities necessary to execute cross-functional strategies: Analyze and evaluate market opportunities and support due diligence activities with respect to continuous improvement and service catalog. Effectively manage business incidents to resolution and track and report activities. Identify processes and standards for proactive management of operational business incidents. Work proactively with market stakeholders to identify opportunities for improved cross-functional (e.g. Billing, Claims, Enrollment, Benefits, Customer Service) efficiency.
- Other duties as assigned.
- Bachelor's Degree in Business Administration/Management, Economics or Health Administration - Substitutions: 6 years of Sales and/or Business Operations
- 5 - 7 years in Operational Excellence
- Master's Degree Business Administration/Management, Economics or Health Administration
- 3 - 5 years in Program Management
- 3 - 5 years in Project Management
- 3 - 5 years in Healthcare Industry
- 3 - 5 years in the Health Insurance Industry
- 3 - 5 years in IT Infrastructure
- Strategic Planning
- Analytical Skills
- Process Improvement
- Communication Skills
- Presentation Delivery
- Presentation Development
Employee Referral - Level 1
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