Provides leadership & management to implement & maintain new/existing benefits, plans, & products to support the employer group & member enrollment processes, care delivery, customer service, & benefit & claims administration both internally & w/ external vendors. Maintains knowledge of policies & procedures & performs in accordance w/ applicable regulatory requirements, external laws & accreditation standards as they relate to membership, benefits, & claims administration.
Essential Functions:
- Manages the day to day activities of Benefit Analysis & Configuration (BAC) staff & enables the team to support ongoing operations & production work to support new/existing benefit, contract & claims administration. Ie.interviewing, selecting, training, motivating, evaluating, counseling, disciplining & termination of employees in compliance w/ EEO/AA goals & personnel policies of the organization. Coaches individuals regarding performance & behavioral development
- Determines how to use resources to meet agreed upon team objectives & participates in developing & monitoring department budget
- Prioritizes daily operations in combination w/ multiple project deliverables to ensure steady & balanced staff workload
- Reviews business needs/requirements & provides recommendations to support & administer new/existing products, benefits & contracts considering customer, clinical, pricing & regulatory implications. Includes the development & implementation of new & improved processes & tools to improve efficiency & ensure optimal results
- Recommends system enhancements by bringing specific product & benefit administration business knowledge to the technical design process
- Uses business, technical & analytical expertise to provide guidance to staff.
- Ensures the accuracy of benefit & plan configuration, e.g.web-based & legacy systems, to support products, benefits, membership, contracts, & claims administration. Develops & maintains data management standards & policies
- Act as escalation point for issues & provides or recommends resolution
- Serves as a liaison between the internal & external product/benefit stakeholders & Benefit Analysis & Configuration Team
- Ensures benefit/plan information quality & compliance in accordance w/SOX controls. Develops & performs quality assurance processes. Knowledgeable in all applicable KP Policies, local, state & federal laws & regulations, & accreditation standards
- Develops, monitors & regularly reports department metrics to support department production & quality processes in alignment w/SOX controls
- Provides project management to achieve business objectives
- Supports regional user testing activities for benefits & plans to include fixes, new releases, enhancements, & interfaces. Reviews system changes to determine impact to testing needs, & business processes
- Ensures development, documentation & implementation of BAC business process changes due to system enhancements/fixes
- Ensures training materials are developed & training is delivered to product/benefit stakeholders as necessary
- Other duties as assigned
- In addition to defined technical requirements, accountable for consistently demonstrating service behaviors & principles defined by the Kaiser Permanente Service Quality Credo, the KP Mission as well as specific departmental/organizational initiatives
- Also accountable for consistently demonstrating the knowledge, skills, abilities, & behaviors necessary to provide superior & culturally sensitive service to each other, to our members, & to purchasers, contracted providers & vendors
Qualifications:
-A minimum of 4 years or more of work experience w/ business systems analysis/administration, benefit administration, claims administration, or product development/management
- A minimum of 4 years supervisory experience required
- Bachelor's Degree or Equivalent Experience may be considered
- Demonstrated operational management skills required
- Proficiency in Microsoft Office Suite
- Excellent interpersonal & communication skills - verbal & written
- Strong detail orientation
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.