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State Health Plan Operations Director

Company: Blue Cross and Blue Shield of North Carolina
Location: Durham
Posted on: September 13, 2019

Job Description:

JOB DESCRIPTION

The State Health Plan (SHP) Operations Director has primary responsibility to ensure successful delivery of the end to end operational functions supporting the SHP, our company s largest ASO customer. In a matrix relationship, this Director role will have authority for operational direction and decision making for the membership/billing, claims, and customer service functions. This position will serve as subject matter expert and act as the primary point of contact for the external customer requiring interaction with the State Treasure as well as the State Health Plan leadership and staff reporting to the Treasurer. Also, this key role will work with internal business owners, segment leadership, and other business partners.

* Maintain and leverage deep expertise of designated business channel, including policies, end to end procedures, contract requirements and unique needs, providing advice and support across CGSO functions.

* Act as decision maker on key operational issues taking accountability for operational performance results and meeting customer expectations

* Serve as the primary point of contact to the external customer on end to end operational needs with a strong focus on timely and accurate issue resolution and root cause analysis

* Represent operational needs and interests for line of business with Sales team, performing analysis of historical operational data and projections to inform product offerings and contract negotiations

* Champion channel-specific needs throughout the organization, assisting Core Production and Core Service leadership with management of escalations, complex issues and ongoing problems

* Within a matrix structure, lead and collaborate with Core Production and Service leads to identify areas that drive member and customer escalations

* Support management and execution of strategically-aligned, channel-specific projects, including process updates, system changes, compliance actions, etc.

* Prepare the team and internal customers for future changes to improve account implementation service, group on boarding, and eligibility maintenance process overall.

* Identify and establish new processes and methodologies to improve the ability of team to successfully deliver member and group enrollment.

* Create and update dashboards to monitor performance of key metrics

* Hold weekly onsite meeting with the SHP leadership to provide updates on ongoing performance, improvements and future initiatives

HIRING REQUIREMENTS

* Bachelor s degree

* 8 years of experience in operational leadership covering a variety of functions including membership/billing, claims, customer service and the interface with the financial and reporting functions.

* A background in client relations, account management or liaison role in marketing and/or operations in the insurance industry.

* Must have solid understanding of end to end operational process

HIRING PREFERENCES

* Proven experience in a customer facing role, effectively managing customer/client expectations while balancing internal organization needs.

* Excellent oral and written communication skills

* Strong communication and negotiation skills

* Ability to proactively identify issues or concerns and strong risk mitigation skills

* Ability to manage relationships and create stakeholder buy-in

* Strong customer service and team building skills

* Good sense of policy implication on contract performance.

* Ability to effectively manage multiple priorities and projects

* Consistent demonstration of leadership behaviors ( i.e. training, mentoring, assisting peers with issue resolution)

#LifeAtBlueCrossNC.

Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities.

Keywords: Blue Cross and Blue Shield of North Carolina, Durham , State Health Plan Operations Director, Healthcare , Durham, North Carolina

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