Director - Health Insurance Operations

JOB DESCRIPTION SUMMARY

• A high-level position reporting to the Assistant Vice President of Operations, who is responsible for directing and planning eligibility administration and finance billing for group health benefit plans for Western Growers Assurance Trust (WGAT), Pinnacle Claims Management Inc. (PCMI) and Covered California for Small Business. Relies on extensive experience and judgment to plan and accomplish goals. Responsible for developing policies and procedures relative to enrollment and eligibility administration, premium billing, non-premium invoicing and remittance, and financial reporting of these activities. This position will have three direct reports, one manager, one Project Specialists and one Business Operations Excellence Analyst.

QUALIFICATIONS

• BS/ BA Degree in related field, advanced degree a plus, and 10 plus years in group health benefit administration, specific to eligibility, premium billing and invoicing.
• Six Sigma designation preferred.
• PMP, CAPM designation preferred.
• Ability to develop departmental budgets.
• Ability to evaluate Profit and Loss statements to ensure compliance with budget.
• Proven ability to mentor and develop staff.
• Extensive Knowledge of the ACA, ERISA, COBRA, HIPAA, FSA AND HSA administration.
• High level of competency in computer skills including BenAdmin systems, Eligibility systems, and Microsoft Office Suite.
• Strong written and verbal communication skills.
• Proven ability to multi-task and handle many projects and demands.
• Verifiable, clean DMV record and the ability to travel to various locations throughout the U.S. (mainly California and Arizona) up to 25% of the time.

DUTIES AND RESPONSIBILITIES
Department Operations

• Develop, implement and monitor successful administrative processes and procedures to maximize employee production and compliance with ERISA, CDI, DOL and CCSB regulations.
• Assign task for project management and develop goals and strategies to achieve successful improvements in all areas of responsibilities and related activities.
• Prepare annual budgets for areas of responsibility.
• Regularly track group/departmental costs, ensuring these are managed within budget. Employ cost containment measures while retaining quality and efficient operations and a productive, healthy work environment. Anticipate expenses and identify potential budgetary concerns to leadership.
• Develop and maintain metrics and measurement (Key Performance Indicators) to support a consistent, informative, and timely management reporting package, weekly to AVP, monthly to Senior Leadership, quarterly for the WGAT Trustees.
• Regularly analyze and report on the productivity and effectiveness of the operations in comparison to established performance metrics. Identify areas of improvement and recommend resolution.

Process Improvement

• Plan, deploy, and lead all lean activities that will produce significant cost savings though productivity, quality, waste reduction improvements, and improving business processes.
• Oversee and guide the development of comprehensive process improvement plans to be shared with stakeholders.
• Develop and promote data-driven solutions.
• Train frontline supervisors on continuous improvement and leadership skills.

Leadership

• Develop, manage, and lead a team of 3A+ self-accountable professionals.
• Develop a culture of real, personal accountability by modeling the behavior that defines it.
• Instill a culture of safety and expectation, within your respective area/s.
• Require direct reports to hold themselves accountable to high standards of, performance and personal conduct, in a clear, helpful, straightforward way.
• Conduct one-on-one conversations with every direct report, on a quarterly basis, focused on their 3A+ capabilities, impact, and effort.
• Make decisions and choices, impacting staff, by using the selection and hiring, clarifying roles and objectives, managing performance, correction & discipline and termination steps as outlined in the “Outward Mindset Skills for Leaders” guide.
• Ensure a robust mentorship, leadership, management and technical training programs are in place to continually develop staff.
• Create a succession and career development plan for all staff members within area of responsibility.

Other

• Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning and executing work in a helpful and collaborative manner, being willing to adjust efforts to ensure that work and attitude are helpful to others, being self-accountable, creating positive impact, and being diligent in delivering results.
• Maintain a clean DMV record and the ability to travel to locations throughout the U.S. (mainly California and Arizona) up to 25% of the time.
• All other duties as assigned.

PHYSICAL DEMANDS/WORK ENVIRONMENT

• The physical demands and work environment described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand, walk and sit. The employee is frequently required to use hands to finger, handle, or feel objects, tools, or controls and reach with hands and arms. The noise level in the work environment is usually moderate.