Strategic Delivery & Risk Management Consultant

Job ID: J122162
Company: Highmark Inc
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: May 3, 2018

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Description

JOB SUMMARY

This job defines, plans, implements and successful delivers Individual/Small Group Market's Open Enrollment Process (OEP). Oversees and manages all activities necessary to maintain efficient business mitigation & control processes, while ensuring adherence to all applicable state and federal regulatory standards. Ensures assigned 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. Acts as the primary Business Interface to Strategic Operations and IT towards strategic delivery. Promotes a risk aware culture; ensure effective risk & compliance management practices by adhering to required standards and processes. The incumbent is primarily responsible for representing Highmark Individual and Small Group Markets with HMHS and HPO for the identification of critical market operations issues, oversight for cross functional issue resolution, resource alignment, assurance for processes or capabilities definition based on business direction, and oversight that monitoring controls are institutionalized. Reports to the Vise President, Market Performance and Implementation within the Individual/Small Group Markets organization.


ESSENTIAL RESPONSIBILITIES

  • Provide wing-to-wing leadership for Open Enrollment process (OEP). Organize, direct and coordinate cross-functional activities to focus corporate resources on the successful delivery and implementation of the OEP while adhering to all state and federal laws and regulatory standards.

  • Assess risks that might jeopardize successful achievement of the desired results of OEP, develop risk mitigation strategies and tactics, and implement risk mitigation plans.

  • Participate and lead key Strategic Initiatives. Identification and justification of strategic projects that drive value and differentiation of Individual/Small Group Market products in the local and national markets to ensure they are planned and executed successfully. Participate in budgeting and budget adherence.

  • 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.

  • Manage daily direction of work processes and prioritization with assigned staff monitoring as necessary to ensure accurate & timely OEP readiness, Risk Mitigation and Strategic Initiatives Delivery. Ensure operational excellence relative to the OEP, Strategic Initiatives and related compliance activities.

  • Serve as the subject matter expert for OEP related work processes and systems. Provide subject matter guidance and leadership to internal Individual/Small Group Individual market's teams as well as matrix partners. Conduct and implement lessons learned to continuously improve the OEP and Initiatives delivery processes adapting to business needs.

  • Document processes and requirements and establish operational policies and procedures and ensure accurate implementation
  • Review existing OEP 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 OEP process.
  • Participate in internal and external audit activities including onsite audits and reporting requests.
  • Prioritize & resolve high impact potential problems collaboratively and effectively using strong judgment, thought leadership and critical thinking.

  • Other duties as assigned or requested.


EDUCATION

Required 

  • Bachelor's Degree

Substitutions

  • None

Preferred

  • Master's Degree/MBA in Business, Health or Economics

EXPERIENCE

Required

  • 8 years in Strategic Initiatives Delivery/Operations Management in a leadership role
  • 5 years in the Health Plan Industry

Preferred

  • 3 years in Individual/Small Group Products and/or OEP
  • Experience in external vendor management and leading operational initiatives for an annual enrollment process
  • Medical business risk mitigation experience
  • Experience with ACA business and operating in the post Health Care Reform environment

LICENSES AND CERTIFICATIONS

Required

  • None

Preferred

  • None

SKILLS

  • Strong facilitation and cross-functional expertise
  • Comfortable managing uncertainty and ambiguity

Language (Other than English)

None

Travel Requirement

0% - 25%

PHYSICAL. MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-Based

Teaches/trains others regularly

Never

Travel regularly from the office to various work sites or from site-to-site

Does Not Apply

Works primarily out-of-the office selling products/services (sales employees)

Does Not Apply

Physical work site required

Yes

Lifting: up to 10 pounds

Occasionally

Lifting: 10 to 25 pounds

Rarely

Lifting: 25 to 50 pounds

Does Not Apply

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 position 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
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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