Job Details

Job Summary

This job manages the development and execution of short-term and long-term objectives to standardize business practices and enhance system applications. Actively participates in and leads projects. Develops and implements appropriate controls and processing methods and manages adherence to. Manages staff responsible for addressing daily system and process issues. Provides leadership in the development, implementation, management, and accurate maintenance of all contractually-based producer arrangements. Establishes and maintains all operational and system processes across the organization to support producer arrangements.

This role can be remote or hybrid - If you are within 50 miles of an office you are required to be onsite 3 days a week - T, W, Th.

Essential Responsibilities

• Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.
• Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
• Lead the delivery and execution of projects by: analyzing, identifying and problem solving business and systems issues; presenting recommendations to senior management; managing development of requirements, standard operating procedures, functional roles and responsibilities, process flow and user guides. Serve in consulting/training role to direct reports to develop and execute comprehensive test scripts decreasing likelihood of defects to be corrected after implementation.
• Identify, research, determine, implement and validate solutions, fostering an environment of continuous improvement across the organization. Oversee ongoing analysis and implementation of procedures and systems. Contribute to operational readiness, organizational change management, solution capability, packaging and estimating, planning and delivery management.
• Lead the development and implementation of contractually-based producer arrangements by: interpreting and translating requests for enhanced business considerations; identifying operational capabilities and/or limitations in delivering requested enhanced business considerations; presenting and working through recommendations with senior management; defining operational process and necessary system development to implement and maintain agreed-to enhanced business communications. Communicate enhanced business considerations and operational processes across the organization. Establish and manage audit controls to ensure enhanced considerations are consistently and accurately adhered to.
• Manages employees in the following analytical functions: 1) Analysis and approval of retroactive Producer changes, exception or advance payments, non-standard commissions, and requests for refunds from Producers; 2) Determination/ set-up of payment arrangements, data transfer, and licensure / appointment procedures for business partners; 3) Maintenance/dissemination of state requirements for producer appointment and licensing; 4) Production of complex reports for Sales, Producers, Business Partners, Regulators and other business areas and external parties; 5) Monitoring and internal auditing of various business partners relative to payment and producer of record accuracy, appointment compliance and other controls; 6) Maintenance of workflow procedures, form communications, and messaging.
• Maintains master Producer contract forms, coordinates amendments and re-distribution of contracts, and works with the legal department on complex contractual issues and special language requests. Acts as custodian/business owner of the payment processes and functional project manager of commission cycle. Coordinates/approves payment system enhancements, relevant system requirements for corporate projects and business partner implementations. Works with other business areas to resolve complex system issues and payment problems.
• Other duties as assigned or requested.

Education

Required: Bachelor's degree

Substitutions: 6 years related and progressive experience in lieu of Bachelor's Degree

Preferred: Master's Degree

Experience

Required: 5 years in Healthcare, Technology or Project Management + 3 years in a leadership or management role

Preferred: 5 years performing or managing administrative and compliance processes related to Producer Relationships

Licenses or Certifications

Required: None

Preferred: None

Skills

Customer focus, results orientation, strategic thinking, change advocate, continuous improvement, talent development

Knowledge of Producer agreements, commission payment calculation and how it interfaces with company financial systems.

Demonstrated competency in project execution and management of organizational units

Excellent written and verbal communication skills

Excellent leadership and interpersonal skills

Proven ability to build and sustain internal and external customer relationships

Experience evaluating and implementing technology

Presentation experience

Strong strategic development capabilities with creative problem-solving skills

Language (Other than English):

None

Travel Requirement:

0% - 25%

Physical, Mental Demands and Working Conditions

Position Type: Office-based Teaches / trains others regularly Constantly Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required No Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum: $78,900.00 Pay Range Maximum: $147,500.00 Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ...@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J273519