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Director, Senior Health Services Key Accounts in Southfield, MI at AF Group

Date Posted: 9/9/2018

Job Snapshot

Job Description

COBX Senior Health Services

Key Accounts





SUMMARY:



The Director, Medicare Advantage Key Accounts is responsible for strategic direction, leadership, development, financial management/performance and execution of Medicare Advantage (MA) results for the Key Accounts. This position directs multiple cross-functional processes across the enterprise including, but not limited to, work performed by Tessellate, Health Plan Business, Advantage Solutions, other affiliated Blue plans nationally, and more. This role establishes strong consulting relationships and positions MA as a thought leader with the customer in coordination with the BCBSM Customer Units.



RESPONSIBILITIES/TASKS:




  • Oversees all principal activities related to maintaining, developing, and executing on the MA financial arrangements including, but not limited to, carve out vendors, incremental arrangements, and ad hoc pricing.
  • Creates short and long term solutions that addresses key areas of concern for Key Accounts and serves as an executive sponsor representing MA on committees/workgroups to ensure successful implementation.
  • Works in tandem with HPB team to develop strategic plans and principal activities related to servicing external Union representatives
  • Oversees all principal activities related to MA Contracts established between the customer and BCBSM/BCN, to minimize any and all financial risks and to maintain current standards on agreed upon performance levels.
  • Oversees all principal activities related to servicing and escalated inquiries and appeals generated regarding the MA plan.
  • Oversees all principal activities related to MA data reporting and data analytics for Large Accounts.
  • Oversees all principal activities related to CMS initiatives for the segment both internally and externally, including, but not limited to, providing strategic direction, consulting, communications, and reporting.
  • Directs a team responsible for ensuring Key Accounts customer satisfaction for MA products.
  • Performs other related duties required.
  • Provides vision, leadership, planning, project coordination, and management for the development of a cost-effective department while concurrently facilitating efficient operations to meet current and future business needs within the organization.
  • Represents Company in community and industry, programs, and conferences.
  • Upon request, functions as the department head in the absence of the executive leader.
  • Participates in the development of programs as a strategic partner that supports the company plan.
  • Participates in development of annual departmental budget, monitors budget, and identifies budget discrepancies. Researches cause and make recommendations.
  • Responsible for balancing workload to optimize the effectiveness of the department.

    DIRECTION EXERCISED:

    Directly supervises exempt and non-exempt staff in accordance with company policies and applicable Federal and State Laws. Responsibilities include, but are not limited to, effectively interviewing, hiring, terminating, and training employees; planning, assigning, and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; supporting and encouraging the engagement process.

    This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.



    EMPLOYMENT QUALIFICATIONS:





    EDUCATION:



    Bachelor's degree in Marketing, Finance, Business Administration, or a related field. Master's degree in a related field preferred. Valid Michigan Accident and Health Insurance License and valid, unrestricted driver's license is required within 90 days of the employee's start date or the license expiration date. Relevant combination of education and experience may be considered in lieu of degree. Continuous learning, as defined by the Company's learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.



    EXPERIENCE:



    Ten (10) years of progressively more responsible experience in a Health Care/Insurance environment with demonstrated technical experience that provides the necessary knowledge, skills and abilities. Five (5) years management or supervisory in Health Care/Insurance required.



    SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:




  • Knowledge of the insurance industry and issues impacting healthcare costs
  • Deep understanding of BCBSM business strategies and business processes, and how they work together
  • Ability to build internal capabilities, and assemble and develop a supporting management team.
  • Ability to develop productive relationships with providers and clients to sell products.
  • Ability to frame and structure problems, discern critical issues, and drive solutions.
  • Ability to successfully manage, develop, and lead a business.
  • Excellent oral and written communication and customer service skills
  • Strong presentation skills and decision making ability.
  • Ability to successfully manage a business and large scale projects.
  • Ability to effectively integrate multiple processes and systems to achieve desired results.
  • Strong understanding of the market and how it differs from Middle & Small to individual, and how large group business is driven largely by relationships, consulting, and being innovative.
  • Knowledge of what the customer and the organization needs and the ability to implement change effectively.
  • Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
  • Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
  • Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
  • Must demonstrate leadership ability and team building skills to effectively supervise professional and non-professional staff and interact with all levels of management.
  • Ability to work with and empower others on a collaborative basis to ensure success of unit team.
  • Ability to effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions, and employing active listening techniques.
  • Ability to effectively present budgetary and/or cost information, and respond to questions as appropriate.
  • Ability to establish workflows, manage multiple projects, and meet necessary deadlines.



    WORKING CONDITIONS:



    Work is performed in an office setting with no unusual hazards. Travel is required.

    The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.

    We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.





    EMPLOYMENT QUALIFICATIONS:





    EDUCATION:



    Bachelor's degree in Marketing, Finance, Business Administration, or a related field. Master's degree in a related field preferred. Valid Michigan Accident and Health Insurance License and valid, unrestricted driver's license is required within 90 days of the employee's start date or the license expiration date. Relevant combination of education and experience may be considered in lieu of degree. Continuous learning, as defined by the Company's learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.



    EXPERIENCE:



    Ten (10) years of progressively more responsible experience in a Health Care/Insurance environment with demonstrated technical experience that provides the necessary knowledge, skills and abilities. Five (5) years management or supervisory in Health Care/Insurance required.

    Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled
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