Highmark Health DirectorTraining Development & Quality in Pittsburgh, Pennsylvania

Description

JOB SUMMARY

This job leads all aspects of Health Plan Operations training, development and quality processes. This includes analyzing training needs, designing learning solutions that meet strategic business and performance objectives, and implementing appropriate learning-related strategies, tools, and processes. Additionally this position will have direct oversight for ensuring the appropriate controls are in place for quality control measures within the HPO production functions. The incumbent will lead the internal quality team to support Customer Service, Claims, High Dollar, Benefit Coding, Billing and Enrollment. These duties support the quality direction within HPO service provider partners to comply with all requirements; ensures appropriate controls are in place throughout the division; oversees ongoing analysis and implementation of performance management procedures and systems related to the successful accurate completion of claims aid inquiries; and researches/resolves all identified procedural discrepancies.

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; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.

  • Direct cross functional training and development strategies and initiatives across the entire Health Plan Operations function. Ensure learning meets both the current and future needs of the organization which are aligned with the strategic strategy.

  • Define training and development Key Performance Indicators in alignment with Health Plan Operations goals and strategic initiatives. Responsible to ensure training deliverables meet the business performance needs of the organization and make an impact to overall success.

  • Develop strategic plans that position the learning function to improve the performance of the business and enable execution of the organization’s strategy.

  • Responsible for oversight of the quality function to drive consistent improvement and high quality standards throughout the Health Plan Operations function. Oversight for appropriate tracking, trends and analytics for errors and performance with in the HPO production units.

  • Oversight for expanded strategic partners/vendor initiatives to support key business initiatives of on and off shore activities

  • Other duties as assigned.

EDUCATION

Required

  • Bachelor's Degree in Business, Learning, orrelated field

Substitutions

  • 6 years of relevant work experience

Preferred

  • Master's Degree in Business, Learning, orrelated field

EXPERIENCE

Minimum

  • 7 years experience analyzing customer needs, designing and implementing learning, quality and related solutions and processes years

To include

  • 5 years management experience

Preferred

  • 7 years experience in a service industry, consumer industry or Fortune 200 company

  • 5 years additional experience in training or adult education or organizational development

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

REQNUMBER: J135408

Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity