Job ID: J135408
Company: Highmark Inc
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Nov 5, 2018
This job leads all aspects of Health Plan Operations training, development and quality processes. This includes analyzing training needs, designing learning solutions that meet strategic business and performance objectives, and implementing appropriate learning-related strategies, tools, and processes. Additionally this position will have direct oversight for ensuring the appropriate controls are in place for quality control measures within the HPO production functions. The incumbent will lead the internal quality team to support Customer Service, Claims, High Dollar, Benefit Coding, Billing and Enrollment. These duties support the quality direction within HPO service provider partners 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.
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies
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
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