Company :Highmark Inc.Job Description : 

I.    GENERAL OVERVIEW:  
Manage and develop all direct and indirect reports with responsibility for handling all claims processing and adjustment workloads for multiple customer segments. Maintaining the Professional Consultant network, performing the Medical review, translating foreign claims and processing claims with unique processing arrangement. Fully utilize the support mechanisms available to complete the required delivery of high performance, low cost production.  Supports strategic planning under the direction of the Director.  Be able to select, develop and continuously coach staff to the highest levels of performance.  Motivate and team build through the creation of a work environment and conditions that contribute to highest levels of performance.

II.    ESSENTIAL RESPONSIBILITIES:  
1.    Communicate effectively
2.    Provide functional area staff coaching.
3.    Manage preparation and implementation of area objectives and ensure these are met in accordance with strategies.
4.    Ensure workload standards are met through efficient utilization of staff in collaboration and support of the command center, regular audits of relevant systems as well as up to date statistics and reports.
5.    Evaluate trends, customer feedback and business initiatives and changes to ensure appropriate planning, training and allocation of resources to successfully achieve desired performance objectives.  
6.    Analyze issues specific to functional area and create business cases to support recommendations on further development of the current processes, procedures and staffing.
7.    Daily monitor, observe, and evaluate various work processes and individual skills applied in the work place to achieve optimum performance and model behavior.
8.    Other duties as assigned or requested.

III. QUALIFICATIONS:
Minimum

High School Diploma or GED5 years management experience5 years experience in large operations environment3 years experience with insurance products principles, industry practices and processes

Preferred

Bachelors degree

Knowledge, Skills and Abilities  
Have an in-depth understanding of the system in which that work is performed – the process, tools and the people – and be able to cost effectively produce the highest levels of high quality output and throughput. This includes knowing how the inputs and outputs of the process area they manage impacts upstream and downstream processes

IV. SCOPE OF RESPONSIBILITY:
Does this role supervise/manage other employees?     Yes 
If yes, indicate the number of direct reports:

V. WORK ENVIRONMENT:
Is Travel Required?  No 
 

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.

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 their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

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 their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

EEO is The Law

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