Senior Vice President, Health Plan Operations
PacificSource

Job Info

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Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

The SVP, Health Plan Operations is a key member of the Senior Leadership Team, reporting to the Chief Executive Officer. The SVP, Health Plan Operations plays a key role in developing and implementing the Company's strategic and business plans with a focus on designing operational processes, member and provider touchpoints, and operating systems to support health risk identification and management, operational excellence, compliance, and a culture supportive of employee development and satisfaction. The SVP, Health Plan Operations partners closely with other senior leaders to ensure Company's Operations meet customer needs and expectations and meet or exceed market competitive standards.

The SVP, Health Plan Operations is responsible for key functions, including claims processing, payment integrity, customer service, product configuration and implementation, membership, enrollment and billing, business continuity, quality assurance, grievance, operations training, performance measurement, project prioritization and operational capacity planning, among other duties. The role ensures company processes are compliant with regulatory and legal requirements across multiple states and lines of business, and ensures systems and processes are operating in accordance with products sold, contractual commitments, performance guarantees, and business policies. The SVP, Health Plan Operations also ensures company processes deliver on management goals including quality, timeliness, and efficiency, regularly developing and implementing quality/process improvement initiatives to continuously improve performance. The SVP, Health Plan Operations is responsible for developing and achieving business unit production and financial targets and requirements based on Line of Business market requirements, federal and state regulatory requirements, contractual agreements, and enterprise budgets. The SVP, Health Plan Operations maintains a deep knowledge of industry best practices and makes recommendations to ensure Company systems and processes remain market competitive.

The SVP, Health Plan Operations works with Line of Business owners to develop and implement business processes and systems that meet the unique customer and market needs of each Line of Business.

As a key leader, the SVP, Health Plan Operations has responsibility to continuously assess organizational strengths and weaknesses to drive a high-performing operating model, recruit top talent, develop organizational bench depth, cultivate a culture of trust and transparency, and reinforce the Company's mission and values in daily work.

Essential Responsibilities:

• Oversee Operations to achieve budgeted profit results and other financial criteria and to preserve the organization's assets.
  
• Oversee the development and implementation of procedures and controls to promote efficient and effective Operations, adequate internal communication and management control.
  
• Coordinate activities of division with all other divisions, departments and committees to ensure smooth and efficient plan Operations.
  
• Delegate portions of activities and responsibilities, as necessary and desirable, to organization staff and managers. Ensures that the responsibilities, authorities and accountabilities of all direct reports are defined and understood.
  
• Provide oversight to ensure that all activities and Operations are performed in compliance with local, state and federal regulations and laws governing business Operations. Direct implementation of administration of all new products, contracts, and plan modifications.
  
• Operate division with maximum efficiency, accuracy, consistency and quality of service. Work with department managers to identify and implement opportunities for increased efficiency and/or service improvement.
  
• Responsible for systems, processes, and controls in reporting department Operations. Ensure coordination of reporting department activities with other departments and support services.
  
• Participate as a member of the Executive Management Group, direct the Operations Committee, and coordinate Operations with Vice Presidents and Directors of other organizational units.
  
• Oversee the development and preparation of short-term and long-range plans and budgets based upon broad organization goals and growth objectives. Recommend their adoption to the Chief Executive Officer.
  
• Communicate operational goals and activities to work units to achieve organizational goals established by the Chief Executive Officer and Board of Directors.
  
• Provide oversight to ensure that all activities and Operations are performed in compliance with local, state and federal regulations and laws governing business Operations. Direct implementation of administration of all new products, contracts, and plan modifications.
  
• Assist the Chief Executive Officer in investigating, evaluating and negotiating acquisition, merger, new business venture and other growth opportunities in accordance with the objectives and plans established by the Chief Executive Officer and the Board of Directors.
  
• Responsible for the performance of the Claims, Customer Service, and Membership departments, among other departments.
  
• Responsible for oversight, management, development, implementation and communication of department programs.
  
• Develop and monitor annual department budgets.
  
• Coordinate business activities by maintaining collaborative partnerships with key departments.
  
• Actively participate in various strategic and internal committees in order to disseminate information within the organization and represent company philosophy.
  
• Implement key elements of Enterprise Strategy.
  

Supporting Responsibilities:

• Meet department and company performance and attendance expectations.
  
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  
• Perform other duties as assigned.
  

SUCCESS PROFILE

Work Experience: Minimum 10 years of demonstrated executive level Health Plan Operations experience.

Education, Certificates, Licenses: Baccalaureate degree in business, finance, or management required.

Knowledge: Expert knowledge of insurance industry procedures and protocols, benchmarking techniques, performance improvement, and general management skills. Excellent analytical skills and knowledge of management techniques. Ability to visualize and implement general plans to specific assigned objectives. Anticipates long and short range effects of minor and major changes in the workflow, systems, market environment, legislative climate, and organizational capabilities throughout the company.

Competencies

• Authenticity
  
• Building Organizational Talent
  
• Coaching and Developing Others
  
• Cultivating Networks
  
• Customer Focus
  
• Empowerment/Delegation
  
• Emotional Intelligence
  
• Establishing Strategic Direction
  
• Leading Change
  
• Optimizing Diversity
  
• Passion for Results
  

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 30% of the time.

Skills:

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.
• We are one team working toward a common goal.
• We are each responsible for customer service.
• We practice open communication at all levels of the company to foster individual, team and company growth.
• We actively participate in efforts to improve our many communities-internally and externally.
• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

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