Vice President, Delivery Services & Implementation - Future Clients

Highmark   •  


Industry: Managed Care & Health Insurance


8 - 10 years

Posted 365 days ago

This job is no longer available.

HM Health Solutions Inc.

Job Description : 

General Overview:

Responsible for directing client relationship activities including:

Core platform business and technology services delivery and ongoing Request for Service process and Global Account Management. Migration of the book of business. Supporting implementations of New National Account Growth Supporting implementations of Ancillary Product (dental, vision, vision retail and stop/loss) growth.

Accountable for managing and further strengthening the account relationship, including execution of strategy and tactical activities required to support the business case as well as the future needs of the client (and other ASP partners) while also protecting Highmark’s interests.   The leader provides direction and leadership to internal Highmark management and staff regarding client needs and objectives; focus on high-performing delivery of contracted services while also effectively managing significant contractual risks & opportunities and coordinating financial, compliance and legal matters between the parties as well as Highmark sub-contractors.

Develops and maintain strong senior management and executive relationships and other ASP partners and acts as a trusted advisor and representative of the Highmark enterprise.   Supports the client to determine current and future services and capabilities necessary to effective complete in a dynamic marketplace and achieve its business objectives in the short and long term.

Essential Job Responsibilities:

1. Manage Highmark enterprise (Health, National Account, Dental, Vision and Stop Loss) business relationship with client, future ASP partners and related critical decisioning, problem resolution, escalation and communications through a complex two-party governance model that ensures appropriate segregation of each company’s management, business intelligence, privacy, trade secrets, etc., while also achieving timely and appropriate decisioning to meet aggressive timeframes without compromising agreed upon guiding principles.

2. Oversee and provide direction on all aspects of the book-of-business migration of ASP -branded and unbranded business, processing and employees to Highmark’s end-to-end core processing systems, business and workflow.   Coordinate with the Highmark Health Solutions on delivery for desired business process and technical outcomes.

3. Coordinate, monitor, drive an liaise with other Highmark and ASP partner functions and related external constituents

  • The prioritization and delivery of all necessary functionality to implement client on the Highmark platform.
  • All planning of Migration and Conversion activities.
  • Ongoing request for service process for client within the SO Delivery Framework.
  • Migration change management process from a Highmark perspective.
  • Coordinate with internal and external legal, finance, audit, IT, business, operations, regulatory, compliance, privacy, and other units as necessary for contract related tasks.
  • Participate in governance forums and provide guidance and contractual, commercial issues.
  • Monitor program level issues across governance forums
  • Proactively follow-up on open action items related to program level issues
  • Collaboratively work with other functions to ensure timely handling of all contractual issues, disputes, escalations etc.
  • Coordinate with other functions to actively manage identified contract risks.
  • Manage internal communication pertain to other units, CXO’s, etc.

4. Coordinate with HHS and manage Balance Scorecard and SLA process for all relationship components as it relates to Highmark Inc.

5. Manage overall business case

  • Monitor performance to ensure business case objectives are achieved and risks are managed aggressively.
  • Identify business case variances and report / escalate, as appropriate.
  • Develop and implement remediation / improvement activities.
  • Optimize value from the contract.

Direct ongoing Contract Administration and oversight of in-scope contracts and agreements

  • Participate in key client contract definition, negotiation, and finalization activities.
  • Assist in defining amendments and additional SOWs
  • Ensure business owners review all financial / commercial terms in contract change requests and ensure compliance with Highmark business strategy.
  • Manage execution and implementation of amendments, additions, deletions to all contract documents.
  • Manage contract review, approval and contract signature process.
  • Ensure appropriate auditing, updating and achieving of contracts and agreements.

6. Serve as credible knowledge originator for business and relationship matters that are particularly important to any ASP partners and the client in their market and other national markets including but not limited to:

  • Competitive landscape for health insurers, TPA’s, dental, vision and stop/loss competitors.
  • Provider landscape and product tendencies of the relevant markets.
  • Develop external relationships with key stakeholders such as board members, government representatives, local business leaders and cultural emissaries, vendor partners, etc.

7. Effectively manages and controls expenses, setting and monitoring performance to budget, maximizing profitability while minimizing expense, and meeting / exceeding profit & loss targets. Stays abreast of emerging technologies and industry trends and applies appropriately.

8. Other duties as assigned or requested.

Minimum Qualifications:

  • 5 years Health Plan-based client management experience working at or with C-level leadership
  • 8 + years of executive or senior client management (Health Plan Client) experience.
  • Bachelor’s  degree in business management, economics, law or related field.
  • 5 years divisional leadership experience of 2-3 major health plan functions.
  • 5 years negotiation experience
  • 5 years prior supplier management experience leading local / regional supplier management teams

Preferred Qualifications:

  • MBA or Masters Degree
  • Solid commercial and legal understanding of sourcing contracts.
  • Strong program and project management and effective time management skills.
  • Ability to manage and monitor outstanding tasks
  • Excellent drafting skills for structuring ideas in a clear and concise manner
  • Keen eye for detail and the ability to maintain standards of accuracy under tight deadlines.
  • Ability to efficiently organize Governance meetings and communication with associated members.