Resp & Qualifications
PURPOSE:Directs NCAS/CFA Account Implementation, Vendor Management, Corporate Systems and Corporate Technology. Directs the Medical Management area for reviews and appeals. Leads Corporate Systems and Vendor Management functions for the SBU.
PRINCIPAL ACCOUNTABILITIES: Under the general direction of the Vice President, NCAS/CFA, the incumbent’s accountabilities include, but are not limited to, the following:
Duties and Responsibilities
1. Account Implementation - Coordinates all aspects of the account implementation process, including LuminX group set-up, plan building and configuration and is responsible for coordinating installation of group accounts on LuminX. Builds and manages strong relationships with Sales to ensure accurate benefits definition and accurate/timely claims adjudication once the account becomes operational. Directs and is responsible for ensuring implementation plan is well executed and managed effectively. Identifies, communicates and resolves account issues in order to achieve and sustain high levels of customer satisfaction. Ensures account ID cards are produced in a timely and accurate manner.
2. Vendor Management - Leads the development of strategic relationships with vendors, brokers, third-party administrators (TPAs) and other external and internal partners. Hire and mentor the team to execute.
3. Corporate Systems - Directs the management of the Corporate Systems area. Facilitate interface with over 150 vendors and ensure that information is readily available at point of service for member ease. Great emphasis on technology to provide web based tools for employers, members and providers for ease of access to readily available information on eligibility, claims, benefits, etc.
4. IT and TPA Technology - Assesses and evaluates the functionality, and efficiency of the LuminX system to assure on-going capability to service accounts. Provides strategic direction for systems capabilities, systems strategies, and workflow implications relative to the LuminX platform. Leads strategic systems initiatives to maintain NCAS competitive edge in systems technologies and to support reengineering of work flows to assure financially sound systems strategies. Direct accountability for the management of network servers and server based operations of the TPA, including integrity, security and infrastructure and coordination with CareFirst Corporate strategies and guidance. Directs the management of and strategic planning for the TPA telephony efforts to include the phone system, equipment and IVR.
SUPERVISORY RESPONSIBILITY: The position supervises a department five - eight managers and their direct reports.
SCOPE DATA: Oversees a department that impacts all NCAS/CFA accounts and their service level satisfaction for new account set up and renewals, oversees corporate technology systems and all vendor relationships, including streamlining, optimizing, etc.
Required: The position requires a Bachelor’s Degree and 10+ years progressive management experience in support service areas or related discipline. Health Insurance experience desirable. Experience in large scale project management, strategic and tactical organizational design and continuous improvement and re-engineering processes is also required.
Abilities/Skills: The incumbent must have exceptional leadership and interpersonal skills, excellent verbal and written communication skills, strong negotiation skills and problem solving skills. The ability to collaborate with all areas of the company, set priorities and goals, and the ability to effectively manage all levels of staff through leadership and the promotion of teamwork is essential in this position.
Must demonstrate resilience and effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. 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.
Preferred: Master’s Degree or other professional certification.
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
Please apply before:3/05/2019
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