Description: The Product Operations job function is responsible for all product operational activities for both new and existing product lines and/or product categories where those products utilize an external vendor and/or internal vendor (as applicable). Responsibilities include development and management of the operational model, production environment and administrative activities for an existing product line and/or product category. The Product Operations job function may be responsible for oversight and management of insurance company transactional based functions (i.e. Claims processing, Customer Service, Billing/Eligibility, Large Claim Review program, various cost containment programs such as Hospital Bill Review and Third-party Liability). Other Product Operations responsibilities may also include the management and delivery of certain regulatory functions (i.e. management of various jurisdictional regulatory required functions such as Special Investigative Unit, Grievance and Appeals Unit, Department of Insurance Market Conduct exams, submission of various regulatory filings).
The Product Operations job function is responsible for leading work throughout the product administration process. The job function will ensure the products being administered meet customer (e.g., member, broker, consultant, purchaser, internal customer, etc) needs and expectations relating to product operations and administration, as well as ensuring that products operate within applicable federal, state and local regulatory requirements. The product and/or product line will also be managed to ensure that industry standard operational metrics are established (examples of success metrics include, budget targets, customer expectations, internal performance metrics, regulatory requirements, etc.), and the line of business operational targets are met or exceeded on a consistent basis.
The product operations role partners closely with other functions such as product development, product solutioning, compliance/regulatory, IT, strategy, Sales & Account management, training, operations and administration etc.
The Product Operation job function is also responsible and accountable for leveraging the applicable components of the Product Development and Management Process (PDMP) and Comprehensive Delivery Process (CDP). The product operation function will provide input on the PDMP process to ensure the process is current and aligned with what it takes to develop and manage products in the current environment.
- May manage a team of product operations managers.
- Manages cross functional teams to ensure Product Operation Process initiatives remain on track and deliver results outlined in business requirements.
- Recognizes linkages and understands impact of individual actions on others or issues on parts of the organization or customer.
- Sees connections, trends and patterns and uses this understanding in weighing potential tradeoffs and formulating operational strategies.
- Uses understanding of interrelationships among systems and processes across functional areas to redesign processes, improve efficient and ensure optimal results.
- Chooses, recommends and or adopts techniques, standards and methodologies to apply to problems solving or improvement initiatives.
- Makes recommendations for improvements to KP standards and methodologies.
- Responsible for managing vendor relationship(s) including network management where applicable.
- Responsible for gathering, collating and analyzing vendor & internal operational process metrics including variance analysis.
- Manages escalated performance gap failures and negotiates resolution on performance issues.
- Identified broad categories and functional areas that contribute to a successful operations.
- Manages the product operations group to demonstrate value is delivered to a customers.
- Accountable to regional and or functional leaders for the delivery of key operational performance measures.
- For a specific product - Ensures that product operational policies are revised to incorporate best practices and proactively identifies and resolves key issues that have required remediation.
- The Product Operation job function is responsible for leading Executive Sponsorship and stakeholder engagement after the product has been launched and throughout the remainder of the lifecycle. This responsibility includes identifying stakeholders, establishing and communicating regular updates on product performance, opportunities for discussion, and preparation product operational performance reviews with executive leaders and/or governance bodies. In addition, there will need to be extensive engagement with the Sales and Account Management, Marketing, Health Plan Administration, operational leadership and MSBD-VP and/or business line leadership.
- Otherresponsibilities for product operations may include responsibility for vendor management, network management as needed based on the nature of the product, involvement in ensuring operational fixes and/or administrative issues are handled, business process and policy and procedure development and implementation support, change management, development or refinement of product performance tools and communication.
- Designs and recommends changes and enhancements to operational processes and policies.
- Develop and adopts best practice Program Wide operational policies and practices that result in flexibility and which accommodates a wide variety of choice to meet customer needs and ensure regulatory compliance while minimizing differences that could affect inefficiencies in administration.
- Provide SME support and education around product features and administrative processes for a broad range of internal and external constituents, including employer groups, brokers, members, KP Sales & Account Management and Regional product development, production management and other functional stakeholder groups (e.g., actuarial/pricing, underwriting, market research, competitive intelligence, legal, HealthConnect, Diamond, etc.), business line stakeholders (e.g., FEHB, National Accounts, etc.), regional stakeholders (e.g., regional benefits design staff), and Systems/IT partners (e.g., DSS, KPHC, Claims, etc.).
- Develops and drives the execution of Product Operations initiatives and new product implementations.
- Increase product operational alignment across the regions in order to provide one KP face to the customer.
- Management and execution of various Insurance Company functions to comply with company policies as well as legal and regulatory requirements.
- Independent Contributors in this Product Operations job function may also require a high level of proficiency in, Program Management and Project Management with experience in consulting, health insurance, insurance, operations, health plan administration, contract administration, health insurance benefit design, benefit configuration, claims processing, customer service, provider (medical group) billing operations, medical terminology/medical coding, COB/Medicare, pharmacy operations.
- Minimum eight (8) years experience in product operations, customer/vendor management, health insurance, health plan administration, benefit policy administration or related field.
- Bachelor's degree or four (4) years of experience in a directly related field.
- High School Diploma or General Education Development (GED) required
Job Number: 672613