Manager Performance Reporting and Analytics

Company :

Highmark Inc.Job Description :

JOB SUMMARY

This job develops and manages operational quality reporting for the company's insurance entities and partners. The incumbent interacts with a wide spectrum of stakeholders including, but not limited to, employees receiving results on their individual performance, employer groups, the Blue Cross Blue Shield Association (BCBSA), state and federal governments, and executive management.  Works closely with divisional leadership and sales on strategies for retention and growth of client relationships with plans who partner with the company to perform quality functions on their behalf.

The incumbent manages a team of resources accountable for blueprinting, requirements development, testing, and prioritizing the portfolio of projects supporting the enterprise quality application.  Collaborates  with Project Managers, Reporting Analysts, Application Development leadership, and Data Scientists to develop project deadlines and ensure timely deliverables.

Oversees the team responsible for identifying trends and issues in customer service, claims, enrollment, billing, and other member touchpoints using complex analysis and algorithms. Partners closely with business process owners and organizational leaders to consult on ways to improve accuracy, efficiency, and consistency, provide recommendations to resolve issues, and to ensure compliance measures are aligned, sustainable, and operating effectively.
The incumbent executes the Performance Assurance programs aligned with the overall Audit & Compliance strategy.  All employees must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI) as described in the Notice of Privacy Practices and Privacy Policies and Procedures. As a component of job roles and responsibilities, employees in this role may have access to covered information, cardholder data, or other confidential customer information which must be protected at all times.  In connection with this responsibility, employees in this role must adhere to all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

ESSENTIAL RESPONSIBILITIES

• Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. 
• Plan, organize, staff, direct and control the day-to-day operations of the department; develops and implements policies and programs as necessary; may have budgetary responsibility and authority. 
• Participate in relevant industry work groups, collaborate with other Blues Plans for leading practices, and understand the performance reporting requirements established by the BCBSA, the Federal Employee Program (FEP), the Centers for Medicare & Medicaid Services (CMS), applicable state Medicaid contracts, state insurance laws, employer group contracts, partner plans, and operational reporting requirements for employees.
• Manage cross-functional, cross-site projects, performs quality assurance to confirm that deliverables meet compliance and customer standards, and ensure adherence to reporting deadlines.
• Conduct and accountable for advanced data analysis (utilizing information intelligence technologies - Tableau, SAS, Cognos) of health information datasets and capable of utilizing highly complex design algorithms, including designing experiments, testing hypotheses, building analytic models, querying and mining large data sets to discover transaction patterns, examining data, and filtering for targeted information using traditional as well as predictive/advanced analytic methodologies to proactively identify trends.
• Develop business cases as required to remedy issues identified from analytics program and leads the team, in alignment with strategic priorities, to meet the analytic and knowledge needs of our stakeholders/customers.  
• Work with department leadership to professionally market the company’s operational quality services and technology to acquire new and expand existing client relationships.  This includes, but may not be limited to, interacting with business leadership to make dynamic presentations, delivering product demonstrations to large and small groups from within and outside the company, and/or providing analytics and reporting delivery thought leadership.
• Collaborate with customers to enhance processes, create efficiencies, understand issues, focus on those issues driving quality scores, and recommend business solutions.  Collaborate with other members of the organization to deliver in an integrated manner that minimizes the impact on customers
• Implement and direct transparent processes that align and prioritize reporting and analytics initiatives, as well as enable sound data governance, management and quality.  This includes, but is not limited to, developing and implementing reporting and analytic solutions that enable consistent, reliable customer-facing functionality that advances strategic initiatives and overall enterprise offerings.
• Accountable for blueprinting, requirements development, testing, and prioritizing the portfolio of projects supporting the enterprise quality application (HMA).  Ensure seamless integration of new partners and/or affiliates into the overall Performance Assurance systems and processes. 
• Other duties as assigned or requested.

EDUCATION

Required

• Bachelor's degree in Business Administration, Quantitative Analysis, Mathematics, and/or other health-related degree, or relevant experience and/or education as determined by the company in lieu of bachelor's degree

Preferred

• Master's degree in Business Administration, Quantitative Analysis, Mathematics, and/or other health-related degree

EXPERIENCE

Required

• 7 years of combined audit, project/program management, data analysis, reporting, and/or quality assurance experience in a large, matrixed organization

Preferred

• 2 years of sales or business development experience
• 5 years of health insurance experience in an operations, reporting, quality, or compliance role
• 2 years of prior management experience, including demonstrated increasing and progressive responsibility

LICENSES OR CERTIFICATIONS

Required

• Driver's License

Preferred

• Tableau Qualified Associate, Tableau Certified Professional, SAS Certified Big Data Professional , PMP, Six Sigma

SKILLS

• Strong program and project management skills
• Demonstrated initiative and leadership skills, including ability to lead by example, experience in mentoring and developing staff, and ability to deliver tough messages with clarity and sensitivity
• Strong analytical background in statistics and mathematical optimization, forecasting and simulation
• Solid, broad knowledge of Information Technology infrastructure including networks and other sources of data, relational database techniques, and data mapping
• Working knowledge and clear understanding of MS Office, Windows and delimited load files requirements and analysis
• Extensive knowledge of assessing and recommending solutions in adherence with industry and regulatory standards
• Excellent ability and a proven record of success with identifying and addressing client/customer needs, developing and sustaining deep client/customer relationships, using networking and conflict resolution skills, actively participating in client discussions and meetings, communicating value, executing engagements including preparing concise, accurate documents, and proactively managing resources project workflow, budgets, billings and collections, in both routine and non-standard situations
• Excellent written and oral communication skills.  This includes the ability to communicate findings and recommendations to the senior management team and customers

Language Requirement (other than English)

None

Travel Requirement

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-Based

General Description for Office-Based Positions

Teaches / trains others regularly

Constantly

Travel regularly from the office to various work sites or from site-to-site

Occasionally

Works primarily out-of-the office selling products/services (sales employees)

Occasionally

Physical work site required

No

Lifting: up to 10 pounds

Does Not Apply

Lifting: 10 to 25 pounds

Does Not Apply

Lifting: 25 to 50 pounds

Does Not Apply

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 any category protected by applicable federal, state, or local law.

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