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Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This position is responsible for Setting and Executing the Growth Strategy for Highmark’s TPA business. This role requires creating, hiring, leading and coaching a team of professionals to maintain and grow Highmark’s TPA business. This responsibility includes but is not limited to the successful creation and execution of the Strategic Plan. This accountability related to the Strategic Plan consists of growing membership, revenue and margin, exploring potential mergers and acquisitions as well as strategically thinking through the positioning of the TPA. This also includes carrying out the execution of the mission, vision, values, Core Behaviors, strategic objectives, and strategic initiatives that support Highmark’s corporate objectives related to national business. This job provides strategic leadership in the development of short- and long-range objectives, policies, budgets, and operating plans for the TPA business. To assure stability, direction/vision, achieve growth and attain segment and Enterprise goals. Establishes the management structure, defines the culture, and provides overall leadership and direction by which the organization operates. Is accountable for the overall performance and results of the organization as well as management and control of the affairs and property.

ESSENTIAL RESPONSIBILITIES

• Work with external partners (TPA’s, Sales, Brokers, and Consultants) to deliver a viable and sustainable TPA business unit.

• Lead Internal teams and Business Partners to complete project activities and deliverables on time and on budget.

• Define the TPA strategy and roadmap. Oversees the affiliation life cycle/implementation and ongoing support requirements.

• Further develop the pricing and staffing model needed in order to ensure the business’ ongoing success.

• Ensure all TPA operations are in compliance with BCBS Association requirements and state and federal regulations.

• Introduce and market new products/services by developing time-integrated plans with internal and external partners.

• Accountable that the appropriate mix of products, services and solutions are available to serve the TPA market.

• Responsible to develop an ongoing approach that will grow share in the market.

• Serve as the point of contact for all TPA issues for resolution.

• Work with internal business partners in evaluating third party partnerships and additional growth opportunities.

• Lead the development of an operation reporting structure and a health dashboard that encompasses the success and failures of the operations.

Strategic Planning Execution:

• Lead the implementation of financial and operational strategy

• Communication of strategy to management

• Lead the development and implementation of sales, financial, operational and marketing strategies to respond to market conditions and demands.

• Review relevant financial information and make relevant adjustments.

• Create and execute on growth and potential acquisition strategies

• Financial Operations Oversight

• Approval of financial reporting including monthly reports to COO

• Respond to all significant trends regarding sales, membership, vendors, commissions, product performance, expense variances and other revenue fluctuations.

• Lead the development of the annual budget.

​ Operations Oversight:

• Lead the development and implementation of technology and process improvements to reduce administrative costs, make it easier for customers to do business with HNAS and enhance capabilities to continue to grow in the respective markets.

Lead a highly effective team:

• Lead an organization that deploys managerial and other staff resources effectively.

• Provide developmental and growth opportunities for direct reports

• Provide regular coaching and feedback to direct reports

• Ensure a collaborative senior management work team that is focused on achieving business goals in a preferred work environment

• Other duties as assigned

EXPERIENCE

Required

• 10 years of experience in Health Insurance Sales Management, Health Plan Operations, Provider Contracting or TPA Services.

• 7 years of management experience

Preferred

• Highmark or BCBS Experience

• Strong relationships with key external stakeholders (brokers/Consultants) in PA, DE, WV, NY and/or CA market

• Experience Selling to large Self-funded Customers

• Marketing experience

• Extensive management level experience in the TPA sector or background in dealing with large Self-funded clients.

SKILLS

• Demonstrate qualities of leadership, analysis, administrative ability, and communication skills. Ability to plan, initiate, direct, and carry out short and long-term priorities.

• Ability to communicate effectively both orally and in writing is a must.

EDUCATION

Required

• Bachelor's Degree in Business, Healthcare Administration or a related field OR Extensive management level experience in the private or public sector with background in business and/or health management.

Preferred

• Master's Degree in Business Administration.

LICENSES or CERTIFICATIONS

Required

• State specific Producer License Life, Accident & Health are required or obtained within 45 days of hire

Language (Other than English) :

None

Travel Requirement:

25% - 50%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Hybrid

Teaches / trains others

Occasionally

Travel from the office to various work sites or from site-to-site

Occasionally

Works primarily out-of-the office selling products/services (sales employees)

Occasionally

Physical work site required

Yes

Lifting: up to 10 pounds

Rarely

Lifting: 10 to 25 pounds

Rarely

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies .

_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. _

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

$198,900.00

Pay Range Maximum:

$400,468.00

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Req ID: J250719