Manager Operations Quality Control

Job ID: J127251
Company: Highmark Inc
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Jul 13, 2018

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Description

JOB SUMMARY

This job sets the quality direction with the division to comply with all requirements; ensures appropriate controls are in place throughout the division; oversees ongoing analysis and implementation of performance management procedures and systems related to the successful accurate completion of claims aid inquiries and researches/resolves all identified procedural discrepancies. 

ESSENTIAL RESPONSIBILITIES

  • Communicate effectively.
  • Plan, direct, organize, develop and monitory quality improvement unit activities.
  • Analyze and recommend solutions to resolve root cause issues leading to claims and inquiry processing errors.
  • Ensure operational regulatory compliance.
  • Maintain a current knowledge of the claims and customer service industry.
  • Other duties as assigned or requested.


EDUCATION

Required

  • High School Diploma or GED

Preferred

  • Bachelor's Degree

EXPERIENCE

Required

  • 5 years experience in Claims Processing or Customer Service
  • 3 years of Management or Leadership Experience
  • 3 years experience presenting and communicating to large audiences
  • 3 years experience utilizing insurance principles and practices

Preferred

  • 2+ years Project Management experience

SKILLS

  • Broad working knowledge of customer service and claims processing systems
  • Understand corporate strategic vision and organizational structure
  • Familiar with benefits/products offered and stay current of inquiry trends
  • Possess operational skills to adequately integrate operational plans and systems
  • Ability to evaluate technology for implementation to gain improved services
  • Strong influencing, negotiating and analytical thinking skills
  • Ability to be creating and practical development, implementation and analysis of the quality program

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.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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