Employment Spot

Job Description

SUMMARY

Managing the activities of  processing for insurance enrollment and member reconciliation including new program set-up, systems evaluation for special processing requests, interfacing with internal and external clients, and serving as a liaison to group insurance administrators for ongoing operational processing.

Oversight of the analysis, design, testing, deployment, and maintenance of custom software, third-party application software, interface development, operational reporting, and vendor management

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following.  Other duties may be assigned.

• Manage and ensure a successful implementation of external vendor systems and appropriate interfaces with systems.
• Act as the FACETS interface between the  business and IT
• Create the layout for configuration for enrollments and the ongoing processing of member adjustments.
• Manage the systematic implementation of government  regulations and related products.
• Demonstrate ability to apply knowledge of health insurance operational areas and managed care products as well as knowledge of other competitors operations and products including current trends in the industry.
• Manage, review, monitor and control the membership systems and process operations with efficiency and effectiveness.
• Able to utilize prior experience to design configuration management procedures which ensure quality and leverage industry best practices. 
• Able to document and implement new system/process policy and to train others in the critical success factors of the policy. 
• Meet with high-level internal and external executives from client organizations and governmental agencies to resolve problems and implement new programs.
• Develop quality and production standards to ensure efficient workflow and evaluate the performance of employees.
• Demonstrates knowledge of the strategic alignment of IT solutions with business objectives.  Identifies and addresses critical technical success factors for enterprise scaled projects. 
• Able to establish technical and architectural strategies, standards and direction based on exploitation and innovation of evolving technologies and how the business operational processes will benefit from those technologies. Intuitively able to identify and evaluate strategies to mitigate associated risks. Able to effectively communicate the technical and architectural strategy, standards and direction to internal and external entities with varying technical knowledge.
• Manage the design, implementation, and revision of internal departmental systems and procedures.

SUPERVISORY RESPONSIBILITIES

Manages subordinates whose responsibilities range from offshore representation to imaging and systems analysis.  Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws.  Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

Job Requirements

QUALIFICATIONS 

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION and/or EXPERIENCE

• Expert FACETS knowledge
• Bachelor's Degree in Business Administration, Management, Technology, or related field
• 10+ years of working experience in group healthcare  either within operations or technology
• Strong working knowledge of programming
• Prior experience will include full responsibility for system development, project management, setting adequate staff levels and hiring staff as needed, establishing departmental budgets, preparing and executing corporate and departmental strategic plans, and making formal presentations to management, staff and customers.
• Strong communication, planning, and organizational skills
• Ability to meet stringent deadlines
• Proficiency in Microsoft Applications

LANGUAGE SKILLS

Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents.  Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community.  Ability to effectively present information to top management, public groups, and/or boards of directors.

MATHEMATICAL SKILLS

Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry.  Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.

REASONING ABILITY

Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.

PHYSICAL DEMANDS 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

WORK ENVIRONMENT 

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.