Director, Operational Analytics & Quality

Job ID: J116457
Company: Highmark Inc
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Feb 8, 2018

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Description

General Overview:

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.

Minimum Qualifications:

  • Bachelor’s degree
  • 8 years of experience in two or more significant business IT or analytical functions
  • 3-5 years of management or leadership experience
  • 7 years of experience in large operations environment
  • 7 years of experience evaluating technology for implementation
  • 7 years of experience statistical and quantitative/qualitative analysis, industry practices and processes

Preferred Qualifications:

  • Master’s degree
  • 5 years of experience of insurance product knowledge
  • 5 years of experience in workforce development and resource management
  • 3 years of experience marketing or selling services for operational capabilities
  • 3 years of experience with project management

Knowledge, Skills & Abilities:

  • Excellent leadership skills
  • High standard of professional conduct
  • Excellent business writing skills
  • Ability to maintain confidential information

Referral Award Level: 4

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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