Responsibilities• Responsible for supervising and overseeing team responsible for benefits, medical policy and product operations enablement. Solutions for complex benefit exceptions in FOS and HRP.
• Manage team and implement departmental policies and procedures with all internal and external business partners.
• Evaluates projects, mandates, initiatives, capacity plans and efficiency of department and takes actions to assign resources and estimate work effort appropriately.
• Responsible for overseeing and managing team ticket inventory to ensure timely resolution across client setup teams.
• Responsible for identifying trends to improve quality and inform training and DLP needs.
• Ability to synthesize data to develop a clear course of action based on information from a variety of sources.
• Develop and ensure timely, complete, and accurate responses to business partners.
• Collaborate with Operational leaders to identify business process improvement opportunities.
• Responsible for extensive downstream impacts; including but not limited to claims processing, costs to self-funded customers, cost to modify coding, compliance with state and federal regulations, adherence to filed benefits, client and member dissatisfaction.
Qualifications
- Bachelor's Degree
- Minimum 7+ years proven management and working experience in operations, medical policy and product management.
- Client Setup, Benefits, Medical Policy and Claims knowledge strongly preferred.
- Ability to manage teams with tight deliverables.
- Demonstrated effective communication skills required to address and present most complex ideas and concepts to staff, management, vendor and external customers (as needed).
- Demonstrated advanced analytical and problem-solving skills.
- Demonstrated ability to define business solutions, make decisions, identify problems, coordinate resources and implement changes.
- Ability to develop, plan, and create timelines and dashboards to support senior management visibility.
HybridIndependence has implemented a "Hybrid" model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the "Hybrid" model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.
