Supv Operations I/II (Local Claims)

Job Description : Summary :

Summary :

Under the direction of the Assigned Management and in accordance with policies, directives and control, supervises, directs and is accountable for all functions of assigned personnel.

Provides supervisory leadership to employees assigned to the department. Identifies and drives initiatives related to the improvement of current work process through trending and analysis.

Essential Primary Responsibilities / Accountabilities :

All Levels :

• Accountable for ensuring a positive customer experience through supervision and direction of the work of assigned employees.
• Leads the activities of staff to ensure all assignments and available work are completed timely and accurately so as to best achieve departmental, organizational, and corporate goals and to fully utilize the skills and abilities of functional employees.
• Identifies and resolves errors and trends, applies appropriate corrections, and identifies process improvement opportunities.
• Monitors key reports and metrics on a daily basis. Understands the data presented and has the ability to take corrective action without further management intervention.
• Maintains knowledge of current systems, benefit changes, market segments, project management, to ensure department is compliant with appropriate regulations and is delivering high-quality customer service levels.
• Responsible for employee performance and will provide coaching to employees to ensure performance meets targets. Conducts regular performance reviews and development plans identifying areas needing improvement and initiates action to assure performance intervention is done when and where necessary.
• Instructs or otherwise acts as resource to employees in dealing with special or unique problems which may involve communication and collaboration with other areas of the organization to drive resolution.
• Works in partnership with personnel across the Health Plan by meeting with constituents to develop post implementation or issue resolution work plans, provide work plan status and / or present Operations overview.
• Responsible for the oversight of customer calls. Serves as an escalation point for complex issues and irate customers outside the normal scope for customer care advocates.
• Prepares requested reports, some of which may be regularly scheduled, others of a special nature.
• Actively participates and makes recommendations regarding the development and maintenance of functional procedures, convenes and conducts informational meetings with employees, and performs other regular supervisory duties.
• Responsible for maintaining qualified staff, including selection, training and placement. Continually evaluates the work force as to their performance and takes action to strengthen each individual.
• Maintains frequent outside contacts with physicians, providers, subscribers and company benefit representatives to provide and obtain information.
• Keeps abreast of developments within the Division, Marketing Operations, Sales, Health Plan and Compliance by attendance at seminars, meetings and workshops;

perusal of publications and as necessary independent study.

• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and Leading to the Lifetime Way values and beliefs.
• Models the Lifetime Way behaviors and values on a consistent basis and promotes these behaviors to the division. This includes focusing on leadership development to ensure we are hiring, developing and retaining leaders to deliver operational excellence.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are in compliance with these requirements.
• Conducts periodic staff meetings to include timely distribution and education related to departmental and Ethics / Compliance information.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

Level II : In addition to Level I responsibilities :

• Accountable for supervision and direction of staff in units that provide coverage which may be national in scope or that manage multiple regions.
• Periodically may collaborate with other areas of the business to establish and manage performance guarantees.
• Occasionally participates in regulatory activities and other escalated issues as required.
• Serves as member of committees that are external to OPEX but internal to Health Plan.
• May be required to create presentation materials for and facilitate FAQ sessions at external customer locations in conjunction with other areas of the business.
• May be required to act as a project stakeholder to represent the department on a corporate project or initiative.

Minimum Qualifications :

Note of Classification : We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and / or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others.

In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.

All Levels :

Bachelor's Degree in Liberal Arts, Business Administration or related and 3 years of relevant experience, one of which are in a defined leadership role.

In lieu of degree, 7 years relevant experience, one of which are in a defined leadership role.

• Demonstrated conflict resolution experience, exercising excellent judgment.
• Must possess adequate knowledge of insurance and be qualified to act as a resource for subordinates in the resolution and disposition of questionable and / or unique inquiries.
• Must be able to establish effective liaison with other departments of the Corporations as well as external entities to include physicians, subscribers and group representatives.
• Excellent oral and written communication skills.

Level II : In addition to Level I requirements :

• Bachelor's Degree in Liberal Arts, Business Administration or related and 4 years relevant experience, two of which are in a defined leadership role.
• Demonstrated experience interfacing with external constituents required.
• Demonstrated presentation skills preferred.
• Continually acts as a mentor and advisor to peers.
• Ability to interact with all levels of management including Executive.
• Demonstrated desire and ability for professional development.
• Demonstrates initiative and willingness to take on additional responsibilities outside of supervisory scope.
• Proactively identifies issues and takes accountability for developing processes and closing gaps
• Demonstrates global, strategic thinking.
• Demonstrates exceptional leadership.
• No performance issues in last year.

Physical Requirements :

• Work is completed in a normal office environment under fluorescent lighting.
• Ability to use a headset to listen to customer conversations required.
• Must be able to function while sitting at a desk viewing a computer and using a keyboard and mouse for 3 or more hours at a time.
• In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

The Lifetime Healthcare Companies aims to attract the best talent from diverse socioeconomic, cultural and experiential backgrounds, to diversify our workforce and best reflect the communities we serve.

Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture.

We believe that diversity of thought and background drives innovation which enables us to provide leading-edge healthcare insurance and services.

With that mission in mind, we recruit the best candidates from all communities, to diversify and strengthen our workforce.

OUR COMPANY CULTURE :

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s) :

Level I : Grade 206 : Minimum : $58,500 - Maximum : $93,267

Level II : Grade 207 : Minimum : $60,070 - Maximum : $111,114

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity.

The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and / or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

Please note : The opportunity for remote work may be possible for all jobs posted by the Univera Healthcare Talent Acquisition team.

This decision is made on a case-by-case basis.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.