Healthcare - Health Services
4 Year Degree
PHP-NEW PROGRAMS Schedule:
Full Time Shift:
M-F, 8-5 additional hours as needed Hours Per Pay Period:
80 Overtime Option:
License / Certification:
- Bachelor's Degree
- General Purpose of Job:
Lead, support and provide direction to plan operations functions including Customer Service, Network Services, Compliance, Claims, Product Configuration and New Programs. Work in collaboration with other leadership to implement and ensure that new product delivery, programs, and operational changes occurring in these functional areas include involvement and engagement across the health plan. Collaborate with leadership to establish and implement programs and processes that ensure consistent quality, cost-effective and compassionate services delivered to plan members and network providers, allowing PHP to be a top performing health plan in customer service and provider satisfaction. Essential Duties: This job description is intended to cover the minimum essential duties assigned on a regular basis. Associates may be asked to perform additional duties as assigned by their leader. Leadership has the right to alter or modify the duties of the position. OPERATIONAL MANAGEMENT
• Serve as voice for operational areas in development of/and implementation of strategic plans.
• Establish and champion an organized approach to product development, implementation and process change that supports cross-functional decision-making and communication. With collaboration of others, develop project plans to address needs of all internal and external stakeholders. Facilitate integrated problem solving and communication during projects and changes.
• Work closely with Sales, Finance and other plan functions to develop and implement products that are market competitive and meet all regulatory requirements.
• Provide leadership for plan document creation to support all lines of business.
• Support and provide leadership for policy and procedure development and review.
• Develop and actively monitor operational and administrative cost measures. CUSTOMER SERVICE
• Provide leadership and support to the Director of Customer Service and the PHP Customer Service Department, including call center operations, member and provider appeals, member satisfaction surveys and initiatives, quality monitoring for member inquiries, adherence to external accreditation and regulatory requirements, training of staff, and other service related activities. CONFIGURATION
• Serve as leader for the Configuration Team
• Work in collaboration with health plan leadership in setting priorities for new products and changes.
• Identify best practices to support flexibility and cost effectiveness in product configuration.
• Keep plan leadership informed of timing and status of new builds and other changes. STAFF COUNCIL/SERVICE EXCELLENCE
• Serve as leadership/mentor to the PHP Staff Council – help set direction, budget and priorities for this employee activity and fund raising committee.
Work with PHP Service Excellence Program Director to support Service Excellence activities and training at PHP. Develop Service Excellence modules and work with PEPs to deliver training.
Required Responsibilities of the Associate:
• Demonstrates knowledge and maintains and respects patient right to privacy by following the HIPAA Privacy and Security policies and procedures.
• Adheres to ICARE values and standards of behavior (Innovation, Compassion, Accountability, Respect, Excellence).
• Role model behaviors that value the diversity of our associates, patients and customers and supports creating an environment that is inclusive, welcoming and respectful.
• Adheres to established best practices (i.e. Rounding, Thank You Notes, AIDET, etc.).
• Demonstrates commitment to safety by establishing an environment in which safety issues are promptly reported and appropriate actions are taken.
Knowledge, Skills and Experience Required: Education: Bachelor’s degree in healthcare, HR, or business field
Minimum of seven years experience in managed care or health insurance industry. Minimum of five years years management experience in health insurance industry. Cross functional project management/team leadership experience Skills & Abilities:
Strong communication skills required; professional writing, presentation and verbal skills. Ability to communicate complex information in simple language. Ability to work in teams, reach compromise through collaboration to achieve objectives.
Knowledge, Skills and Experience Preferred: