JOB SUMMARY
This role is responsible for the creation, execution, and oversight of the Medicare sales and distribution strategy through partnering with sales leadership and other matrix partners. This role is responsible for ensuring comprehensive compliance and operational excellence across all Lines of Business. Key responsibilities include the oversight and management of all Policies and Procedures, proactive monitoring and implementation of regulatory changes, and the development and maintenance of call monitoring programs. The incumbent will lead compliance call management, conduct robust complaint tracking and trend analysis, and oversee ongoing audit processes. This position also involves acting as a primary liaison for external complaints, tracking coaching and remediation efforts, and delivering quarterly compliance readouts to Sales Management. Furthermore, the role contributes to agent education initiatives, facilitates audit information gathering, manages agent and agency contracts, and oversees third-party risk management assessments for agency partners.
ESSENTIAL RESPONSIBILITIES
- Partner with leadership to set the direction of the strategic business plan and translate it into a vison for the organization.
- Influence all stakeholders to support key projects/programs in order to ensure positive outcomes that deliver results.
- Drive change in order to improve performance results, organizational effectiveness and/or systems/quality/services (e.g. policies, processes, or systems). Identify gaps in processes or organization. Challenge self and others to develop and implement solutions.
- Hold direct accountability for impact to growth initiatives and strategy development. Ensure accurate prioritization of key projects/programs within purview.
- Hold ultimate accountability for project management services being delivered including organizational budget and/or financial implications.
- Assist in the development and execution of micro market strategies to meet expected growth and retention targets.
- Other duties as assigned or directed.
EDUCATION
Required
- Bachelor's Degree in Business Administration/Management or relevant experience and/or education as determined by the company in lieu of bachelor's degree
Preferred
- None
LICENSES/CERTIFICATIONS
Required
- None
Preferred
- None
EXPERIENCE
Required
- 5 - 7 years of Health Insurance Industry experience
Preferred
- 1 - 3 years of Medicare or Program Management experience
SKILLS
- Analysis of business problems/needs and process improvement
- Analytical Skills
- Budget Management
- Business Development
- Collaborative Problem Solving
- Communication and Presentation Skills
- Organizational Skills
- Project/Program Management
- Cross-Functional Team Leadership
- Influence and Persuasion
Language (other than English)
None
Travel Required
0% - 25%
PHYSICAL, MENTAL DEMANDS, AND WORKING CONDITIONS
Position Type
Office-Based
Teaches / trains others regularly
Occasionally
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
Yes
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:
$67,500.00Pay Range Maximum:
$126,000.00Base 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.
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