Job ID: J132854
Company: Highmark Inc
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Sep 26, 2018
I. GENERAL OVERVIEW:
Responsible for definition, planning, implementation and successful delivery of Senior Market's Annual Enrollment Process (AEP). Oversees and manages all activities necessary to maintain efficient business mitigation & control processes, while ensuring adherence to all applicable state and federal regulatory standards. Responsible for ensuring assigned Senior Market's Strategic Initiatives are proactively and comprehensively managed; implementing the sales, marketing and product strategies reducing the risk of non-compliance and meeting or exceeding planned revenue. Primary Business Interface to Strategic Operations and IT towards strategic delivery. Promote a risk aware culture; ensure effective risk & compliance management practices by adhering to required standards and processes.
Employee Referral Payout: Level 1
II. ESSENTIAL RESPONSIBILITIES:
1. Provide wing-to-wing leadership for the Senior Market's Annual Enrollment process (AEP). Organize, direct and coordinate cross-functional activities to focus corporate resources on the successful delivery and implementation of the Senior Markets AEP while adhering to all state and federal laws and regulatory standards.
2. Assess risks that might jeopardize successful achievement of the desired results of AEP, develop risk mitigation strategies and tactics, and implement risk mitigation plans.
3. Participate and lead key Senior Markets Strategic Initiatives. Identification and justification of strategic projects that drive value and differentiation of Senior Market products in the local and national markets to ensure they are planned and executed successfully. Participate in budgeting and budget adherence.
4. Monitor and evaluate the progress, alignment and financial "health" of assigned Strategic Initiatives. Direct corrective actions as needed to maintain the viability of assigned Initiatives. As required - Report to the executive team/sponsor/steering committee on the progress, business impacts and strategies around assigned Initiatives.
5. Daily direction of work processes and prioritization with assigned staff monitoring as necessary to ensure accurate & timely AEP readiness, Risk Mitigation and Strategic Initiatives Delivery. Ensure operational excellence relative to the AEP, Strategic Initiatives and related compliance activities.
6. Serve as the subject matter expert for Senior Market's AEP related work processes and systems. Provide subject matter guidance and leadership to internal senior market's teams as well as matrix partners. Conduct and implement lessons learned to continuously improve the AEP and Initiatives delivery processes adapting to Sr. Market's business needs.
• Document processes and requirements and establish operational policies and procedures and ensure accurate implementation
• Review existing Senior Markets AEP policies and procedures on an annual basis, including management of updates and development of new policies, as needed
• Participate in interdepartmental and intradepartmental problem solving and quality initiatives.
• Prepare recommendations for management on process flow, improvements, and system modifications.
• Develop training for new department staff and related department staff and corporate overviews as necessary to ensure the appropriate level of knowledge to support the Senior Market AEP process.
• Participate in internal and external audit activities including onsite audits and reporting requests.
7. Prioritize & resolve high impact potential problems collaboratively and effectively using strong judgment, thought leadership and critical thinking.
8. Other duties as assigned or requested.
• A Bachelor's Degree in business, economics, engineering or life sciences
• 8+ years of experience in Strategic Initiatives Delivery/operations management in a leadership role
• 5+ years of experience within the health plan industry
• A Master's Degree / MBA in business, health or economics
• 3 years of Senior Products &/or AEP experience
• Experience in external vendor management and leading operational initiatives for an annual enrollment process
• Medical business risk mitigation experience
Knowledge, Skills and Abilities
• Strong facilitation and cross-functional expertise
• Comfortable managing uncertainty and ambiguity
V. WORK ENVIRONMENT
Is Travel Required? Yes
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