Individual Market Segment Manager - 011938

Summary:

This position is responsible for supporting the Individual Commercial Market line of business strategy and execution. The Segment Manager assures that all Individual Commercial products and programs are administered according to approved benefit design, regulatory requirements, and strategic objectives for the line of business. The incumbent is accountable for service and operational requirements associated with the line of business and will be knowledgeable in all Individual Commercial market products including medical, prescription drug, and dental products.

Essential Accountabilities:

• Develops strategic, operational, and tactical business plans to achieve desired business goals for the Individual Commercial lines of business. Conducts evaluation, review, and assessment of various operations for the purpose of identifying root causes of operations problems that contribute to noncompliance and customer dissatisfaction.

• Understands and evaluates new market opportunities including building of necessary business cases.

• Consults with team members and stakeholders to streamline system operations and processes to improve business effectiveness and efficiency. Engages in issue identification as well as problem solving to identify and resolve potential improvement opportunities.

• Serves as a corporate resource for the Individual Commercial segment, providing line of business subject matter expertise to business teams on initiatives and activities that impact the line of business. Develops and maintains relationships across the enterprise to promote consistent strategic priorities. Encourages innovation, process improvements, and personal development within the functional business areas that support the Individual Commercial products.

• Plans, develops, and implements special projects, initiatives, and activities to support line of business objectives, product, benefit administration, regulatory requirements, process improvement, efficiency, and the customer experience. Works closely with other Departments for input and integration. Ensures all perspectives are considered and develops processes and timelines to incorporate planning and execution of strategies across departments.

• Collaborates with cross functional business and project teams to ensure alignment to line of business objectives, compliance, operational performance and process improvement. Ensures cross functional integration of strategies with key internal areas including, but not limited to Marketing, Operational Excellence, Population Health Engagement, Finance, Provider Contracting, Compliance and Analytics, Data and Technology. Represents the Individual Commercial line of business on related key cross-functional committees and projects to ensure Medicare perspective is being integrated into strategies of other areas.

• Manages maintenance of business process work item deliverables. Regularly participates in forums and activities to solicit direct customer feedback.

• Reads, interprets, and identifies necessary next steps related to complex government regulations.

• May serve as a regulatory liaison to NYS, CMS or BCBSA as needed.

• Acts quickly to continuous changes and challenges in the regulatory environment.

• Remains current on evolving market dynamics within the Individual Commercial segment, connects trends to line of business objectives and ensures awareness among key business partners.

• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.

• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.

• Regular and reliable attendance is expected and required.

• Performs other functions as assigned by management.

Minimum Qualifications:

• Bachelor's degree in health administration, marketing, business administration, or related field with six or more years progressive health plan operations experience.

• Project management experience: strong facilitation skills and follow through.

• Current on all relevant regulatory requirements.

• Strong leadership and/or management experience.

• Demonstrated expertise and background working with regulatory and accreditation agencies such as NCQA, CMS, Federal & State agencies including DOH, Dept. of Finance Services.

• Demonstrated analytical and strategic thinking ability; strong process and program management skills, creativity and initiative in problem solving and solution identification.

• Proven effective negotiation skills, particularly in dealing with middle and senior management levels.

• Ability to establish effective relationships with all levels of representation throughout the divisions including senior management to execute cross-divisional initiatives. Exceptional computer skills including MS Word, Excel, and PowerPoint.

Physical Requirements:

• Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer.

• Ability to travel across the Health Plan service region for meetings and/or trainings as needed.

Salary Range(s):

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in additional to internal equity. The posted salary range reflects just one component of Excellus's total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

Min: 70,200.00 - Max: 130,300.00

One Mission. One Vision. One I.D.E.A. One you.

Together we can create a better I.D.E.A. for our communities.

At the Lifetime Healthcare Companies, we're on a mission to make our communities healthier, and we can't do it without you. We know diversity helps fuel our mission and that's why we approach our work from an I.D.E.A. mindset (Inclusion, Diversity, Equity, and Access). By activating our employees' experiences, skills, and perspectives, we take action toward greater health equity.

We aspire to reflect the communities we live in and serve, and strongly encourage people of color, LGBTQ+ people, people with disabilities, veterans, and other underrepresented groups to apply.

OUR COMPANY CULTURE:

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation, and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)