Optimizes a significant suite of Specialty TPA Systems, technology platforms, vendors and infrastructure that are key to enabling the Specialty TPA customer experience. Manages the operations and staff responsible for Specialty TPA customer care integrated systems, automated processes, and related vendor relationships. Acts as the primary liaison with IT to implement process improvements maximize vendor product solutions to meet goals and strategic business needs.
Directly manages and controls the progress of overall Specialty TPA operations systems configuration and reporting staff and is accountable for ensuring objectives and deadlines are met for the unit (including but not limited to System Configuration, Subrogation, Claims Billing, Network Fees, Web Portal and Business Solutions).
Acts as the primary liaison between various internal business, sales, service and information systems and technology departments to define needs and translates them into technical requirements. Collaborates with other areas to support direct and indirect customer experience technology needs, issues and trends.
Collects, analyzes and configures operations systems, web and vendor data and initiates, develops and recommends and implements improvements to systems, processes and procedures to increase productivity and reduce cost.
Evaluates and manages system/service/application upgrades conversions, migrations, implementations, enhancements and new solutions.
Ensures staff is current with business area needs, and technical solutions are responsive to business changes and industry trends. Creates and/or generates user and management reports, analytics, modeling and special studies related directly and indirectly to Specialty TPA operations and technology trends.
Manages and participates in corporate projects/initiatives to enhance the overall customer experience.
Performs other duties as assigned.
- Bachelor's Degree in Information Systems, Business Administration, Health Information Management or related field, or equivalent combination of training and experience.
- 6 years progressive health insurance operations, client management, IT liaison, or project management experience, 3 years of which are in a leadership capacity
- Project Management Certification preferred.
- Comprehensive knowledge of and the ability to apply advanced project management methodologies.
- Comprehensive knowledge of contact center systems (i.e. Interactive Voice Response systems, Customer Service Agent Desktop, customer interaction and billing software, workforce optimization tools) and related processes.
- Comprehensive knowledge of System Configuration, Data Warehousing and reporting solutions, Admin, Membership, Billing, Claims, Web, Utilization Management and EDI transactions and technical capabilities and how those varied solutions can support the organization's strategic goals.
- Ability to build relationships and consensus among business partners as to the value and effectiveness of the solutions suggested.
Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:
A Great Place to Work:
- Top Workplace in Northeast Ohio. Year after year we've received this recognition!
- On-site wellness center at most locations. Enjoy personal trainers, towel service, locker room, weight room, elliptical machines, and a variety of classes!
- On-site cafeteria serving hot breakfast and lunch, at most locations. Choices ranging from salad bar, made to order, hot and cold sandwiches, or a variety of entrees cooked fresh daily. Convenience store at most locations
- Employee discount program. Discounts at many places in and around town, just for being a Medical Mutual team member
- Business casual attire
Excellent Benefits and Compensation:
- Competitive compensation plans
- Employee bonus program
- 401(k) with company match and an additional company contribution
- Excellent medical, dental, vision, and disability insurance
An Investment in You:
- Career development programs and classes
- Mentoring and coaching to help you advance
- Education reimbursement up to $5K per year
About Medical Mutual:
We strive to create peace of mind. Our customers can trust us to do things right and to help them get value from their health plan. We're the largest health insurer in Ohio and for over 80 years, we've been serving our members and the Ohio communities where they live and work. Medical Mutual is a Top Place to Work in Northeast Ohio with exceptional career opportunities that offer challenge, growth and a great work/life balance. We want talented, innovative, and driven people to help us continue to be the best health insurance choice of Ohioans and help make Ohio the best it can be! Our headquarter building is located in the heart of downtown Cleveland and we have multiple offices throughout the state. Join us at one near you!
At Medical Mutual we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.
We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.
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