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Blue Cross Blue Shield of Massachusetts Sr. Director, Operations Shared Services l Healthcare in Hingham, Massachusetts

Ready to help us transform healthcare? Bring your true colors to blue.

The primary focus of this role is to lead the Operations Share Services (OSS) Business Unit, a team that manages centralized shared services in support of the broader Operations Division of 800+ leaders and associates. In addition to supporting the Operations Division, the role supports the Enterprise Technology Division and Chief Information Officer in developing and implementing communication and training plans for high profile technology initiatives. This position manages four distinct departments dedicated to ensuring our providers, members, and accounts receive best-in-class service and operational experience. The individual is a key member of the Operations leadership team, partnering with other leaders to develop innovative business strategies to support on-going operational enhancements.

Business Area Accountabilities:

Communication & Education

  • Work collaboratively with project experts (internal IT staff, vendors, business leaders) to ensure a full understanding of the impacts to internal and external end-users from the launch of new tools, services and advise on the communication strategy

  • Employ effective strategies for assessing and implementing communication vehicles (e.g., short videos, online newsletter) to ensure that division communications continue to evolve and address the needs of our changing organization

  • Lead and direct the development and maintenance of new tools that enable and promote effective communication across the division

  • Design and implementation of functional training programs that facilitate the onboarding and continued development of Operations associates based on the core systems and workflows utilized by four distinct business areas (i.e., Enrollment, Provider, and Medical & Dental Claims Operations).

  • Development and execution of a training approach for technology implementations sponsored by Operations leadership and/or with broad user impact within Operations

  • Work with senior leaders in Operations to ensure C&E resources are appropriately assigned to business priorities

  • Collaborates with senior divisional leaders and other Operations leaders to drive the design of inclusive associate engagement and development programs, including the Operations Culture Council

  • Leads the introduction of design thinking principles for identified operations team initiatives and development and engagement activities to enable associates to further build those skills.

Operations Quality Assurance

  • Administration of the associate Quality Assurance programs for Operations across Provider Operations, Claims Operations and Enrollment Operations team

  • Feedback and coaching based on quality results to the 400+ associates supported by the Quality Assurance programs.

  • Conduct quality trend analysis across operational areas of focus and partner with operational leadership and training with a focus on data-driven continuous improvement

  • Partner with Audit and Risk Management in performing Performance Guarantee audits for the claim quality measures.

  • Oversee key controls and processes to review select claims (i.e. high dollars) and develop on-going improvements to mitigate risk to claims quality.

Quality Testing & Audit Support

  • Administer operational testing support across assigned domains, maintenance & enhancement test coverage across benefits administration, payment/medical policy testing, provider directory accuracy, and external audits.

  • Delivery of quality testing functions for the Operations division. This includes but isn’t limited to, effort estimation and forecasting, test architecture, test strategy, test planning and execution, defect management, budget and stakeholder reporting.

  • Development, application, and maintenance of quality standards and written policies and procedures that govern the tasks of the testing function with adherence to both internal and external standards

  • Continuous evolution and maturation of Audit & Testing frameworks in line with technology and innovation strategies for assigned business and system solution areas.

  • Leads continuous quality testing improvements including usage of appropriate testing tools, test techniques, test automation with knowledge of Risk Management, Risk Identification and Risked Based Testing.

  • Develop strategies to design, plan and implement operational risk-based focused audits within Operations to improve overall operational excellence.

  • Partner with Audit & Risk Management and Operations Leaders to identifying and plan new risk-based audit programs to drive operational excellence

Business Operations Support

  • Manage expedited account service issues thru the Central HUB on Salesforce maintaining rapid turnaround and issue resolution to ensure minimal account, member and provider impact.

  • Perform root cause analysis for all escalated issues and collaborate with other teams to determine solutions.

  • Coordinate expedited response for system outages impacting claim processing; identify root-cause, impact, communications, and workarounds thru issue resolution.

  • Manage and lead standard Command Centers as well as special, as-needed Command Centers that take in cross-functional, complex issues impacting multiple teams and lead collaborative solutions.

  • Lead process to resolve all Requests for Research (RFR’s) to resolve issues negatively impacting claims processing.

  • Create and manage databases, reporting, analytics, and applications that support critical business operations functions and audits.

Leadership

  • Lead, motivate, and support associates in achieving business results, division and corporate goals, with a focus on attracting and retaining a diverse and inclusive workforce.

  • Develop individual Performance Plans and, where appropriate, partner with HR on performance and development plans for associates and leaders within the Business Unit.

  • Focus on talent management to build a world class operations environment with stability and excitement through training and consistent feedback.

  • Represent Operations Shared Services (OSS) with key internal partners, such as Sales, Operations, and Enterprise Technology.

Strategy

  • Develop innovative strategies to improve operational efficiencies, quality of configuration activities, and testing automation.

  • Develop and execute outsourcing strategies and manage vendor relationships/contracts that supports service and operational expectations and produces organizational savings.

  • Identify, plan, and develop data to support appropriate staffing and resources needed to achieve business results.

  • Champion process improvements, fostering ownership and empowerment of front-line leaders and associates.

Qualifications (knowledge/skills/abilities/behaviors):

  • Demonstrated competency in the areas of leadership, change management, influence, negotiation skills, staff development, communication, follow through, coaching, and motivation.

  • Ability to prioritize, coordinate and direct decision-making in complex situations and fast-paced operational environment.

  • Demonstrated ability to drive decisions, accountability, performance and follow-through on all business initiatives.

  • Documented strength in analysis, proactive issue identification, and issue resolution.

  • Sensitivity to and respect for individuals at all levels, possessing natural leadership and charismatic qualities responsible to the organization’s needs and able to obtain consistently superior performance from a diverse and inclusive team.

  • Proven leader with a minimum of 10 - 15 years of experience in operations within the health care industry (preferred).

  • Bachelor’s degree in business administration, technology, healthcare administration, operations or related field or equivalent experience preferred.

LocationHinghamTime TypeFull time

Voted as the highest in member satisfaction among Massachusetts commercial health plans by JD Power , Blue Cross Blue Shield of Massachusetts is a community-focused, tax-paying, not-for-profit health plan headquartered in Boston. We have been a market leader for over 75 years, and are consistently ranked among the nation's best health plans. Our daily efforts are dedicated to effectively serving our 2.8 million members, and consistently offering security, stability, and peace of mind to both our members and associates.

Our Commitment to You

We are committed to investing in your development and providing the necessary resources to enable your success. We are dedicated to creating a refreshing and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path. We take pride in our diverse, community-centric, wellness-focused culture and believe every member of our team deserves to enjoy a positive work-life balance.

Blue Cross Blue Shield of Massachusetts is an Equal Employment / Affirmative Action Employer. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or expression, or any other characteristics protected by law.

Blue Cross Blue Shield of Massachusetts will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with Blue Cross Blue Shield of Massachusetts's legal duty to furnish information.

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