Manager Operational Quality Control

Highmark Health · Working at Home · $79,300 (stated in the posting)

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Job Description : 

JOB SUMMARY

**Due to Department of Defense (DOD) contract requirements, the incumbent who fills this position must be a US citizen, and must also pass a background check**

This leadership role is responsible for managing the quality, accuracy, compliance, and operational performance of the Electronic Enrollment function. The position oversees a team responsible for implementing and maintaining electronic enrollment solutions, including client onboarding, establishment of file formats and transmission schedules, configuration of processing profiles, ID card layout development, business and technical testing, and production implementation. The incumbent champions continuous improvement and promotes a culture of innovation and operational excellence by leveraging emerging technologies, process optimization methodologies, and responsible use of artificial intelligence to enhance productivity, decision-making, and service delivery while maintaining appropriate governance and compliance standards.

ESSENTIAL RESPONSIBILITIES

• Perform management responsibilities to include, but not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, and manage the day-to-day operations of the team; develop and implement policies and programs as necessary; manage to assigned budgets.
• The role ensures appropriate controls are maintained throughout the enrollment lifecycle and leads ongoing analysis of operational performance, root cause identification, procedural discrepancy resolution, and implementation of corrective actions to improve quality, efficiency and client satisfaction.  
• This role promotes a culture of innovation and operational excellence by leveraging emerging technologies, process optimization methodologies, and responsible use of artificial intelligence to enhance productivity, decision-making, and service delivery while maintaining appropriate governance and compliance standards.
• The manager fosters strong cross-functional partnerships across Enrollment, Account Installation, Information Technology, Product, Claims, Customer Service and other operational areas to enhance end to end process knowledge, improve organizational effectiveness and drive integrated solutions to complex challenges. Through collaboration and knowledge share, the incumbent ensures alignment across teams and helps remove operational barriers that impact client and member experiences.          
• Other duties as assigned or requested.
  

EDUCATION

Required

• High School Diploma or GED

Substitutions

• None

Preferred

• Bachelor's Degree

EXPERIENCE

Required

• Due to Department of Defense (DOD) contract requirements, the incumbent who fills this position must be a US citizen, and must also pass a background check
• 3 years of Management or Leadership Experience
• 3 years experience in Electronic Enrollment
• 3 years experience utilizing insurance principles and practices

SKILLS

• Builds engaged, high performing team through coaching, mentoring, accountability and empowerment.
• Connects upstream and downstream impacts to develop effective, sustainable solutions.
• Identifies opportunities to simplify processes, eliminate waste, and improve operational outcomes.
• Builds strong partnerships across departments and functions.
• Effectively collaborate with vendors, clients, and technology partners to identify soltuions, implement enhancements and improve service delivery.
• Promotes knowledge sharing and ensures processes are clearly documented, sustainable and accessible across teams.

Travel Requirement

• 0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

• Office-Based

Physical work site required

• Occasionally

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 position 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:

Pay Range Maximum:

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.

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

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