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Director, Front End Operations

Job Description

  • Proactively manages enterprise Front-End Operations (Claims, Enrollment, Grievance & Appeals, and Correspondence) governance, priorities and performance to achieve enterprise direction, quality, efficiency, customer experience, strategic goals, contractual targets.  Manage retained staff, drive auditing, trending, root cause analysis, and resolution of issue.
  • Manage leadership and line management of vendor (SourceHOV/Exela), monitoring daily production, driving continuous operational performance for core front-end processes and resolution of production issues to achieve end-to-end results across the EmblemHealth (EH) and ConnectiCare (CCI) value stream.
  • Manage ConnectiCare (CCI) Mail Center process and operations.
  • Provide oversight of customer experience enhancement by directing continuous process and quality improvement.

 

Responsibilities:

  • Direct operational performance of the $3.5m vendor (SourceHOV/Exela) contract to meet contractual requirements and align with enterprise-wide strategic objectives.  Direct day-to-day vendor operations via daily staff meetings, capability analyses, on-site and transactional audits, quality program verification, compliance reviews, customer experience, policy and procedure reviews, daily meetings with line management counterparts, and corrective action drilldowns. 
  • Drive quality performance of Front-End Operations and direct day-to-day through vendor (SourceHOV/Exela) to ensure contractual requirements align with EmblemHealth’s and ConnectiCare’s business rules and requirements and that they adhere to compliance standards.  Ensure, through daily monitoring of reporting and auditing, that SLAs are met.  Drive resolution of production issues. Conduct daily and weekly huddles with vendor, across all locations onshore and offshore.
  • Oversee quality and performance metrics, communicating and ensuring alliance from an enterprise perspective (EH and CCI), aligning processing, performance, staffing, technology, and priorities with the overall corporate strategic direction.
  • Drive operational readiness at the new Exela location in Windsor, CT being leveraged to process ConnectiCare mail.  Train Exela staff, ensure all processes are intact, resolve production issues. 
  • Manage the transition of ConnectiCare’s Front-End to SourceHOV/Exela.  Collaborate with all CCI departments to build out processes and requirements for all in-scope components, including claims, enrollment, grievance & appeals, and all correspondence.  Drive a streamlined and standardized front-end operational approach across the enterprise (CCI and EH). 
  • Serve as lead Front-End Operations SME for Transformation projects, including: Maestro, PPO Migration, CCI, Micgration, CAG
  • Manage CCI Mail Center process including monitoring daily workloads, maintains schedules for adequate team coverage and assigns staff to appropriate work responsibilities.
  • Interact with various departments throughout CCI to conduct mailings.  Will identify, address and resolve questions, procedures and issues surfacing through communication and contact with both internal and external customers.
  • Negotiate vendor contracts for Mail Center and Front End services to ensure pricing structure and performance guarantees are commensurate with CCI's business objectives and supports financial objective, are administratively sound and promotes 'Best in Class Service'.  Develop competitive bid process and drives vendor selection when appropriate.
  • Collaborate with business partners on requests for new materials and/or changes submitting Data Design Requests as required.
  • Communicate and collaborate with Claims and Enrollment Departments, Mailroom, IT, and other Departmental stakeholders as needed to assess daily status, respond to inquiries, troubleshoot issues, and drive to resolution cross departmentally and with vendor in support of EmblemHealth’s overall quality and customer experience objectives.
  • Communicate and collaborate with Courier as needed to ensure smooth chain of custody of mail.
  • Proactively and clearly communicate milestones, status, selling of ideas and proposals.  (use Executive Briefing Tool)
  • Contribute to transformation/migration projects and new business initiatives by defining business requirements, working with vendor to ensure implementation, and coordinating testing efforts. 
  • Coordinate scanning activities for various departments throughout CCI.  Help lead the integration of scanning activity and champion procedures that will streamline work processes and efficiencies while mitigating risk.
  • Lead, train, evaluate and develop CCI mailroom assigned staff. Apply techniques and personnel policies to ensure the continual development of staff.  Interact with staff to enhance procedures and work flows within the Team and other departments. Identify and recommend new technologies and process efficiencies.
  • Assist in the development and maintenance of a coordinated training curriculum for CCI mailroom new hires and existing Staff. Oversee training sessions designed to support new policies, procedures, and departmental objectives.
  • Identify process efficiencies and opportunities for improvement.  Proactively collaborate and work with all levels of management and staff to implement changes that enhance the customer experience and operational workflow, define and refining new business rules on an ongoing basis, and supporting Enterprise initiatives and process improvements requests.  Draft Change Requests as needed.
  • Foster a collaborative environment and continuously coach and mentor direct reports and vendor staff to achieve higher levels of Vendor Operations Management competencies. Identify and address gaps for developing competencies.  Continually assess activities and processes to ensure efficiency, effectiveness, and added value.

Job Requirements

Requirements:

  • BS or BA degree; Master’s degree required; additional years of experience/specialized training may be considered in lieu of educational requirement
  • 10+ years of relevant experience in Operations Management & Improvement, Change Management, and Customer Experience required
  • Lean Six Sigma certification preferred
  • Vendor Management certification or equivalent certification preferred
  • Experience with outsourced processes and vendor management preferred
  • Experience with staff and process management, including performance management preferred
  • Ability to manage vendor line management and their respective staff on a day-to-day basis required
  • Effective communication skills (verbal, written, presentation, personal interaction) with all types and levels of audiences required
  • Solid coaching and mentoring skills to continuously develop staff core competencies required
  • Strategic and tactical perspective on how to significantly improve operational performance required
  • Proficiency with MS Office (word processing, spreadsheet/database, presentation, e-mail) required

Job Snapshot

Location US-NY-New York
Employment Type Full-Time
Pay Type Year
Pay Rate N/A
Store Type Health Care
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Company Overview

EmblemHealth

EmblemHealth is a local, neighborhood health plan that has served the New York City area and surrounding communities for more than 75 years. That’s the kind of experience that makes us unique. We’re proud to be one of the nation’s largest not-for-profit health plans, serving 3.1 million people who live and work across the New York tri-state area. Learn More

Contact Information

US-NY-New York
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Snapshot
EmblemHealth
Company:
US-NY-New York
Location:
Full-Time
Employment Type:
Year
Pay Type:
N/A
Pay Rate:
Health Care
Store Type:

Job Description

  • Proactively manages enterprise Front-End Operations (Claims, Enrollment, Grievance & Appeals, and Correspondence) governance, priorities and performance to achieve enterprise direction, quality, efficiency, customer experience, strategic goals, contractual targets.  Manage retained staff, drive auditing, trending, root cause analysis, and resolution of issue.
  • Manage leadership and line management of vendor (SourceHOV/Exela), monitoring daily production, driving continuous operational performance for core front-end processes and resolution of production issues to achieve end-to-end results across the EmblemHealth (EH) and ConnectiCare (CCI) value stream.
  • Manage ConnectiCare (CCI) Mail Center process and operations.
  • Provide oversight of customer experience enhancement by directing continuous process and quality improvement.

 

Responsibilities:

  • Direct operational performance of the $3.5m vendor (SourceHOV/Exela) contract to meet contractual requirements and align with enterprise-wide strategic objectives.  Direct day-to-day vendor operations via daily staff meetings, capability analyses, on-site and transactional audits, quality program verification, compliance reviews, customer experience, policy and procedure reviews, daily meetings with line management counterparts, and corrective action drilldowns. 
  • Drive quality performance of Front-End Operations and direct day-to-day through vendor (SourceHOV/Exela) to ensure contractual requirements align with EmblemHealth’s and ConnectiCare’s business rules and requirements and that they adhere to compliance standards.  Ensure, through daily monitoring of reporting and auditing, that SLAs are met.  Drive resolution of production issues. Conduct daily and weekly huddles with vendor, across all locations onshore and offshore.
  • Oversee quality and performance metrics, communicating and ensuring alliance from an enterprise perspective (EH and CCI), aligning processing, performance, staffing, technology, and priorities with the overall corporate strategic direction.
  • Drive operational readiness at the new Exela location in Windsor, CT being leveraged to process ConnectiCare mail.  Train Exela staff, ensure all processes are intact, resolve production issues. 
  • Manage the transition of ConnectiCare’s Front-End to SourceHOV/Exela.  Collaborate with all CCI departments to build out processes and requirements for all in-scope components, including claims, enrollment, grievance & appeals, and all correspondence.  Drive a streamlined and standardized front-end operational approach across the enterprise (CCI and EH). 
  • Serve as lead Front-End Operations SME for Transformation projects, including: Maestro, PPO Migration, CCI, Micgration, CAG
  • Manage CCI Mail Center process including monitoring daily workloads, maintains schedules for adequate team coverage and assigns staff to appropriate work responsibilities.
  • Interact with various departments throughout CCI to conduct mailings.  Will identify, address and resolve questions, procedures and issues surfacing through communication and contact with both internal and external customers.
  • Negotiate vendor contracts for Mail Center and Front End services to ensure pricing structure and performance guarantees are commensurate with CCI's business objectives and supports financial objective, are administratively sound and promotes 'Best in Class Service'.  Develop competitive bid process and drives vendor selection when appropriate.
  • Collaborate with business partners on requests for new materials and/or changes submitting Data Design Requests as required.
  • Communicate and collaborate with Claims and Enrollment Departments, Mailroom, IT, and other Departmental stakeholders as needed to assess daily status, respond to inquiries, troubleshoot issues, and drive to resolution cross departmentally and with vendor in support of EmblemHealth’s overall quality and customer experience objectives.
  • Communicate and collaborate with Courier as needed to ensure smooth chain of custody of mail.
  • Proactively and clearly communicate milestones, status, selling of ideas and proposals.  (use Executive Briefing Tool)
  • Contribute to transformation/migration projects and new business initiatives by defining business requirements, working with vendor to ensure implementation, and coordinating testing efforts. 
  • Coordinate scanning activities for various departments throughout CCI.  Help lead the integration of scanning activity and champion procedures that will streamline work processes and efficiencies while mitigating risk.
  • Lead, train, evaluate and develop CCI mailroom assigned staff. Apply techniques and personnel policies to ensure the continual development of staff.  Interact with staff to enhance procedures and work flows within the Team and other departments. Identify and recommend new technologies and process efficiencies.
  • Assist in the development and maintenance of a coordinated training curriculum for CCI mailroom new hires and existing Staff. Oversee training sessions designed to support new policies, procedures, and departmental objectives.
  • Identify process efficiencies and opportunities for improvement.  Proactively collaborate and work with all levels of management and staff to implement changes that enhance the customer experience and operational workflow, define and refining new business rules on an ongoing basis, and supporting Enterprise initiatives and process improvements requests.  Draft Change Requests as needed.
  • Foster a collaborative environment and continuously coach and mentor direct reports and vendor staff to achieve higher levels of Vendor Operations Management competencies. Identify and address gaps for developing competencies.  Continually assess activities and processes to ensure efficiency, effectiveness, and added value.

Job Requirements

Requirements:

  • BS or BA degree; Master’s degree required; additional years of experience/specialized training may be considered in lieu of educational requirement
  • 10+ years of relevant experience in Operations Management & Improvement, Change Management, and Customer Experience required
  • Lean Six Sigma certification preferred
  • Vendor Management certification or equivalent certification preferred
  • Experience with outsourced processes and vendor management preferred
  • Experience with staff and process management, including performance management preferred
  • Ability to manage vendor line management and their respective staff on a day-to-day basis required
  • Effective communication skills (verbal, written, presentation, personal interaction) with all types and levels of audiences required
  • Solid coaching and mentoring skills to continuously develop staff core competencies required
  • Strategic and tactical perspective on how to significantly improve operational performance required
  • Proficiency with MS Office (word processing, spreadsheet/database, presentation, e-mail) required

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Director, Front End Operations Apply now