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Director Operations

4 months ago

Des Moines, United States Wellmark Full time
Company Description

Why Wellmark: We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we've built our reputation on over 80 years' worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors-our members. If you're passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today

Learn more about our unique benefit offerings here.

Want to know more? You can learn about life at Wellmark here.

Job Description

The Director - Operations Business Support will strategically lead programs and corporate initiatives on behalf of Claims for the Operations division; including overseeing the timely management and resolution of Claims related inquires and issues. You will partner cross-functionally to enhance and optimize end to end processes for claims related initiatives. You should have a passion for cultivating ideas, facilitating, and implementing process improvement initiatives across the business by driving business readiness and change management activities that are focused on ensuring optimal member engagement and experience. This role will focus on supporting the Claims area which includes front end suspense, complex adjustments, project work, system support and enhancements, and cross functional communication and planning. In addition, this role will also be accountable for vendor relationships specific to claims processing.

Qualifications

Required:
  • Bachelor's degree in business, health care administration or related field or equivalent work experience required.
  • A minimum of 7 years of experience in a highly complex industry such as insurance or financial services; including experience in claims, membership & enrollment, and customer service or contact center environment with extensive knowledge of related systems. Including:
    • Prior experience leading and managing enterprise-wide programs/projects. Oversight and execution of full program lifecycle, including program sponsorship, driving business engagement and readiness and technical support.
    • Demonstrated experience formally leading a team, setting clear expectations and performance goals, holding the team accountable for delivering positive results, and providing opportunities to develop team members' skills and experiences.
  • Experience demonstrating effective resource management/planning, budgeting, forecasting and strategic planning.
  • Critical thinking, analytical problem solving, and workflow management skills; demonstrated ability to develop understanding and appreciation for upstream and downstream impacts in processes.
  • Continuous improvement focus; demonstrated ability to simplify business processes through the application of process/quality improvement tools/techniques and project management processes/methodologies including successfully leading change management efforts.
  • Demonstrated customer and partner relationship management skills, including effective communication, presentation, negotiation, and conflict resolution skills; ability to solicit cooperation and action from others not under their direct report by creating a sense of urgency and a teachable point of view.
  • Excellent track record in mentorship and development of direct reports, as well as evidence of positive influence of senior leaders and effective team skills.
  • Proven track record of developing highly effective, collaborative relationships with executives, divisional leadership or operational teams resulting in the consistent development and delivery of strategic business planning solutions.
  • Advanced ability to balance industry expertise and business acumen with strong understanding of the customer. Ability to generate innovative solutions and establishes clear expectations to meet goals and objectives.
  • Exceptional written and verbal communication skills with the ability to articulate actionable business implications and recommendations to varying audiences, including senior leadership and executives. Strong presentation skills, negotiation skills, and the ability to influence others to achieve business results.
  • Highly motivated, adaptable and flexible with strong change management skills. Ability to prioritize strategic initiatives, align appropriate resources, clearly articulate expectations to others, and motivate teams in order to achieve success.
Preferred:
  • Process Improvement and/or Business Project Management experience
  • Prior experience leading technical teams
  • Prior vendor management experience; including managing contracted resources
  • SAFe/Agile methodology experience


Additional Information

a. Provide strategic direction and leadership for a team that supports Wellmark, divisional, and department strategy, tactics and goals. Cascades and communicates strategy and initiatives to team leaders and members while continually seeking opportunities to add value and differentiate our services and supporting achievement of overall company results.

b. Provide day-to-day leadership of financial and human resources, primarily focusing on employee and leader coaching, development, performance improvement, coordination and budgeting for multiple staff, and department(s) specific functions/service.

c. Business Support & System ReadSiness: oversee and execute large-scale system integrations. Act as business owner and/or executive sponsor for strategic investments and operational initiatives, accountable for successful business deployment and driving business outcomes.

d. Provide strategic direction and daily leadership to Operations technical team. Oversee system sustainability, issue escalation, business requirement sessions and user acceptance testing. In collaboration with Technology support teams, ensure post-production validation as well as end to end business operations and reporting teams have achieved desired outcomes.

e. Oversee and lead teams comprised of systems and program support. Develop and implement business readiness plans that support programs and work closely with delivery teams to integrate business readiness plans into the overall program roadmap. Continually monitor and update progress against the strategy, making adjustments to initiatives and resources as needed to ensure successful outcomes.

f. Drive business and change aspects for large-scale/complex program implementations' by ensuring business readiness across the organization, including the development of enterprise-wide training programs and organizational change management activities.

g. Operational Support: oversee the timely management and resolution of enrollment, claims and customer service inquires and issues. Ensure member goals and expectations are met or exceeded for assigned business lines. Collaborate with Sales, Health Services, Pharmacy, Finance, Compliance, Human Resources and Technology stakeholders and leaders to ensure business needs are met, supporting processes are firmly in place, and resources are adequately trained prior to go-live.

h. Lead continuous process improvement and business simplification efforts that result in improved, cost effective standardized processes across the organization.

i. Ensure compliance with business process controls and regulatory requirements through documentation, monitoring and reporting of critical division activities.

j. Other duties as assigned.

An Equal Opportunity Employer

The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.

Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at careers@wellmark.com

Please inform us if you meet the definition of a "Covered DoD official".