Manager - Operations (Business Configuration Quality)

Requisition ID : 850879

Position : Full-Time

Total Rewards :

There’s more to EyeMed than meets the eye. EyeMed is the fastest growing managed vision benefits company in the country with consistent double-digit membership growth! Through our commitment to innovation, we’re reimagining the way employers and their employees think about vision care.

We want them to see life to the fullest and experience more of what’s best, not more of the same. And if what’s best hasn’t been done yet, it’s our exceptional and passionate employees driving this change.

But, our passion for vision isn’t just about vision insurance benefits. Our employees are proud to support and participate in life-altering global and local missions through our partnership with OneSight, a leading not-for-profit organization with a 100% focus on eradicating the world’s vision crisis.

Your family says a lot about who you are. EyeMed is a key member of the Luxottica family of companies, global leaders in the design, manufacture and distribution of fashion, luxury and sports eyewear.

In North America, Luxottica is the home to global brands Ray-Ban, Oakley and many top fashion house brands. Our leading retail brands include LensCrafters, Sunglass Hut, Pearle Vision, and Target Optical.

If you’re passionate about driving innovation and change and interested in a career in the optical and insurance industry, EyeMed wants to start the conversation and help provide you a growth-focused opportunity with America’s fastest growing vision benefits company.

GENERAL FUNCTION

The Manager is responsible for the overall data integrity and quality assurance of product, provider agreement, fee schedule, and network set up.

The Manager will identify, define, and implement new auditing processes as well as spearheading projects that drive solutions to improve the benefit, network, and agreement configuration performed by the Business Configuration production team.

MAJOR DUTIES AND RESPONSIBILITIES

• Lead projects to enhance the audit controls of the Provider Network and Agreement Maintenance (PNAM) application.
• Lead the Business Configuration Annual Soc1 Controls and Managed Vision Care Revenue Quality Audits, responsible for providing the required evidence to support the controls throughout the review process.
• Collaborate with Business Configuration leaders to implement best practices for the audit and quality control of configuration.
• Perform daily quality assurance checks on configuration data as well as lead quality projects for data provider network and agreement configuration.
• Develop an end-to-end audit process for contract acceptance to network / agreement assignment, identifying governance reports that monitor the contract accepted matches the provider assignment.
• Provide assessment, analysis, and troubleshooting of potential data set up issues using SQL Queries to pull data from the system.
• Collaborate with IT on enhancements of automated solutions to deliver improved quality program processing.
• Responsible for identifying, defining, and driving enhancements in audit tools and processes to improve production team performance.
• Oversee and monitor established Performance Guarantees (PGs) for Business Configuration; monitoring and maintenance of PG Performance to ensure production is completed within goal and on time.
• Develop and maintain Quality Key Performance Indicator metrics for agreement, network, and fee schedule errors.
• Create training documentation and deliver training to other team members on auditing processes.
• Perform Business Configuration product, network, and agreement data cleanup activities.
• Perform and resolve network and agreement configuration questions / issues sent to the Business Configuration team.
• Maintain relationships with Account Managers, and Provider teams to develop a cohesive cross functional, results driven working environment.
• Coordinate and participate in cross-functional team activities for issue resolution.
• Recommend process and system enhancements to drive improvements.

BASIC QUALIFICATIONS

• Bachelor’s degree in Business, or related field, or equivalent work experience
• 5+ years’ experience health plans benefit, network, and agreement configuration.
• Previous experience in managing and developing teams
• 2 years’ experience writing basic SQL queries.
• Excellent analytical and problem-solving skills
• Strong communication and interpersonal skills
• Ability to manage multiple complex assignments at once.

PREFERRED QUALIFICATIONS

• Experience in Operations in the Healthcare industry.
• Experience understanding claim adjudication for member and provider reimbursements.
• Experience with Facets platform using Claims, Provider, Network, Product Benefit Configuration
• Knowledge of Medicare and Medicaid programs

Employee pay is determined by multiple factors, including geography, experience, qualifications, skills and local minimum wage requirements.

In addition, you may also be offered a competitive bonus and / or commission plan, which complements a first-class total rewards package.

Benefits may include health care, retirement savings, paid time off / vacation, and various employee discounts.

We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, gender, national origin, social origin, social condition, being perceived as a victim of domestic violence, sexual aggression or stalking, religion, age, disability, sexual orientation, gender identity or expression, citizenship, ancestry, veteran or military status, marital status, pregnancy (including unlawful discrimination on the basis of a legally protected pregnancy or maternity leave), genetic information or any other characteristics protected by law.

Native Americans in the US receive preference in accordance with Tribal Law.