Operations Director (Remote)

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Purpose

Resp & Qualifications

Leads, manages and empowers Medicare Advantage (MA) Employer Group Waiver Plan (EGWP) operations teams to meet and exceed business delivery. Serves as a tactical and strategic leader of multifunctional teams and support roles for MA EGWP. Be able to step-in as subject matter expert in all aspects of MA EGWP operations. Oversees development of new activities of an internal function that provides operational/business process support to internal and external customers for the new EGWP product launch. Ensures quality service and operational performance within the parameters of program and delivery standards are achieved, including CMS required standards. Develops, analyzes operational processes, establishes escalation procedures and oversees training needs assessments to identify opportunities for service delivery improvements. Selects, develops, and evaluates employees to ensure efficient operation of the function. Leads a team of managers to manage operations support teams.

Essential Functions

• Develops and optimizes consistent, repeatable and measurable MA EGWP processes and metrics to quickly adapt to changing business conditions. Leads and work projects that are important to the team related to process improvement.
• Develops MA EGWP operational processes, guidance, processes, metrics, reporting and technology that transform the consumer experience and support company growth
• Accountable for the performance of multiple teams within a related function. Provides leadership and direction through managers.
• Uses data to add value to the customer's MA EGWP operations. Look for opportunities to improve current and integrated processes with other key stakeholders of the EGWP program.
• Designs, launches, monitors performance of critical programs to ensure business commitments and CMS compliance are met, customer experience continue to improve, and drive operational efficiency.
• Develops an understanding of customer experience in all customer support interactions that occur and build to meet/exceed customer expectations
  
  

Supervisory Responsibility

This position manages people.

Qualifications

Education Level: Bachelor's Degree in Business Administration, Healthcare Administration or related discipline OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Experience : 8 years experience in health insurance, call center, claims and/or enrollment and billing environment. 3 years experience in managerial functions in a customer service, claims and/or enrollment and billing or related field.

Knowledge, Skills And Abilities (KSAs)

• Must have extremely strong analytical and problem-solving skills, and the ability to develop and implement policies and programs that will advance corporate and operational goals and objectives.
• Excellent planning, problem solving, presentation, written and oral communication skills are required. Excellent interpersonal skills, the ability to effectively manage a staff through leadership and the promotion of teamwork is essential.
• Must possess excellent interpersonal skills and highly developed written and oral communication skills to effectively convey complex and detailed concepts to a diverse audience.
• Must possess extremely well developed organizational and prioritization skills.
  
  

Salary Range: $129,600 - $240,570

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

FEPMA Operations

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.

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.

Physical Demands

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.

REQNUMBER: 21766

If you have questions about this posting, please contact [email protected]