Resp & Qualifications
Manages the daily activities of a multi-functional operations area. Functional areas may include but not limited to: installation, implementation, client support, client services, client administration, customer service, enrollment and eligibility, claims processing, and call center operations. Investigates and settles claims or other customer service related issues not resolvable by lower staff members.
This position reports to the Director of Operations and the incumbent is responsible for driving the business and technical day-to-day activities and support for enrollment, financial member reconciliation, and associated reporting related to individual commercial and SHOP lines of business. Responsibilities include any new and ongoing financial reporting and reconcilements by identifying, analyzing and, where necessary, changing business practices which adversely impact receivables or the company's cash flow, as well as ensuring appropriate financial and operational controls and procedures are in place and works with external and internal auditors to ensure compliance of controls. Applies accounting principles and procedures to analyze financial information, prepares accurate and timely operational reports to Senior Management and Executive Leadership. This position makes daily operations run with optimum efficiency to achieve all internal and external corporate goals and objectives. Responsible for ensuring high quality, timely, and cost-effective service, as well as for maintaining high levels of customer, peer satisfaction, and subscriber retention. Monitors section performance to ensure that all expectations are met while containing costs to meet financial goals. Recommends, coordinates and directs solutions to improve internal operations and interactions with the state and federal exchanges as well as the Center for Medicare and Medicaid Services (CMS).
Achieves operational objectives by contributing information and analysis to strategic plans and reviews; preparing and completing action plans; implementing production, productivity, quality, customer-service standards; identifying and resolving problems; identifying, developing, and implementing system improvements. Meets departmental financial objectives by estimating requirements; preparing an annual budget; scheduling expenditures; analyzing variances; initiating corrective actions.
Determines operations strategies by conducting needs assessments, performance reviews, capacity planning, and cost/benefit analyses; identifying and evaluating state-of-the-art technologies; defining user requirements.
Manages employee outcomes by recruiting, selecting, orienting, training, assigning, coaching, counseling, and disciplining employees; communicating job expectations; planning, monitoring, appraising, and reviewing job contributions; planning and reviewing compensation actions; enforcing policies and procedures.
Develops call center, claims and or enrollment and billing systems by establishing technical specifications; developing customer interaction and voice response systems, and voice networks; designing user interfaces; developing and executing user acceptance test plans; planning and controlling implementations.
Maintains and improves departmental operations by monitoring system performance; identifying and resolving operations problems; managing process improvement and quality assurance programs; installing upgrades.
Prepares call center, claims and or enrollment and billing performance reports by collecting, analyzing, and summarizing data and trends.
Improves call center, claims and or enrollment and billing and management job knowledge by attending educational workshops; reviewing professional and technical publications; establishing personal networks; benchmarking state-of-the-art practices.
This position manages people.
Education Level: Bachelor's Degree in Accounting or Business OR in lieu of a Bachelor's degree, an additional 8 years of relevant work experience is required in addition to the required work experience.
Experience: 6-8 years progressive experience in operations with time spent in a call center, claims, billing and enrollment, operations environment. 6-8 years supervisory experience or demonstrated progressive leadership. Preferred 4-6 years experience focused on financial control, reporting, reconciliation, and regulatory compliance in a health insurance environment.
Master’s Degree Business Administration with a minimum of 10+ years of financial management / operations experience, with 4-6 years focused on financial control, reporting, reconciliation, and regulatory compliance in a health insurance environment.
Knowledge, Skills and Abilities (KSAs)
Knowledge of call center operations, claims and/or enrollment and billing and work flows.
Strong presentation skills.
Highly proficient in Microsoft Office programs.
Excellent communication skills both written and verbal.
Ability to plan, review, supervise, and inspect the work of others.
Demonstrates expertise in financial operations, and a highly developed understanding of business and key performance measures/indicators.
Ability to work in a fast-paced environment with frequently changing priorities, deadlines, and workload.
Ability to meet established deadlines and handle multiple demands from internal and external customers, within set expectations for service excellence.
Effectively communicate and provide customer service to every internal and external customer, including those who may be demanding or otherwise challenging.
Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Department: Individual Enrollment
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship
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