And Qualifications Directing the operations of the Corporate Performance unit to ensure compliance and accuracy of reported data; and, overseeing the preparation of performance reports. Responsible for communicating results to internal Management and meeting BCBSA requirements for periodic submissions. Analyzing BCBSA Audit Program reporting guidelines; determining the impact on various Plan, subsidiary and vendor processing and operating procedures; initiating necessary actions to ensure compli... more details
Manager, Corporate Performance
Job LocationsUS-PA-Harrisburg
Workplace
Hybrid
Employment Type
Full Time
ID
2024-2987
Position Description
At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”
The Manager, Corporate Performance is primarily responsible for delivering independent and objective assessments of how well the Company is meeting various program metrics that are reported to external stakeholders. Specific programs include Member Touchpoints Measures (MTM), Local Operations Scorecard (LOS), Federal Employee Program (FEP), and the Licensee Desk-Level Audit (LDLA) program, all under the direction of the BlueCross BlueShield Association (BCBSA). In addition, The Manager, Corporate Performance is responsible for measuring and evaluating Operational Performance Guarantees and supporting Account Audits in accordance with employer group contractsThe incumbent manages a team of performance analysts as they test a variety of transactions to determine how well Capital is meeting the performance standards of these programs and respond to external auditor requests to validate Capital’s performance.This position also represents Capital’s interests with external entities including BCBSA, Peer Plan working groups, BCBSA FEP Program Integrity, brokers / audit firms, and accounts.
Responsibilities and Qualifications
Directing the operations of the Corporate Performance unit to ensure compliance and accuracy of reported data; and, overseeing the preparation of performance reports. Responsible for communicating results to internal Management and meeting BCBSA requirements for periodic submissions.
Analyzing BCBSA Audit Program reporting guidelines; determining the impact on various Plan, subsidiary and vendor processing and operating procedures; initiating necessary actions to ensure compliance with program requirements; coordinating changes as revisions are made; testing results to ensure the integrity of Plan reporting; and participating in BCBSA workgroups to evaluate the measures, standards and guidelines of all programs.
Leading Capital’s response to support employer group audits in accordance with the group contract and other legal documentation; coordinating with operations and various business areas to assess results and develop corrective actions; ensuring Capital’s performance response addresses opportunities for improvement and clarifies Capital’s position; and communicating results of audit activities to internal stakeholders and management.
Leading Capital’s Operational Performance Guarantee program that is offered to a variety of employer group customers, including directing cross-functional policy review, reporting to accounts and internal stakeholders and management. Collaborating with Director of Corporate Performance, Sales, Operations, Healthcare Delivery, Pharmacy and other internal stakeholders to ensure compliance with applicable policies while supporting strategies for financial savings.
Collaborating with key stakeholders to offer the best possible responses to requests for proposals (RFP) and market inquiries related to Performance Guarantees and employer group audits.
Coordinating various external reviews conducted by the BCBSA, the Federal Employees Program, the Office of Personnel Management related to Operational measures, and brokers / audit firms.
Supporting special requests from Senior Management, including claim expense analyses, product or account benefit configuration reviews, and support for various Internal Audits. The incumbent participates in Plan projects designed to improve the quality and efficiency of operations.
Forecasting future workloads and analyzes personnel requirements of current and future demands; develops work plans for meeting internal and external reporting requirements; and supports the unit's annual budget and monitors its variances.
Serving as direct line manager for multiple professional audit staff with a focus on: interviewing and selecting new talent; coaching to develop new professional skills and abilities; allocating tasks which further the professional growth and development of team members; providing meaningful feedback on job performance to enhance effectiveness in role and employee engagement; and encouraging development of professional skills through training and growth opportunities, among other people-related responsibilities.
Ensuring testing procedures are periodically reviewed and documented; quality control procedures are appropriate, and results are shared with employees, as necessary; reported populations and samples are appropriate; and any vendor oversight occurs.
Skills:
Effective leadership skills to coach, train, evaluate, and manage diverse staff to deliver on assignments, maintaining high morale and promoting continuous improvement of results and personal/professional development.
Effective workforce management skills, including employee scheduling, work forecasting, productivity and performance management against established metrics.
Excellent analytical and problem-solving skills.
Well disciplined, free of bias, able to plan and take action independently, while maintaining good rapport and relationships with company management at all levels.
Must be highly principled and of the highest ethical standards.
Ability to quickly understand business processes and issues and develop plan to correct.
Possess a sense of urgency to meet deadlines and commitments to stakeholders.
Demonstrates situational awareness and ability to identify and prioritize tasks in advance of explicit direction.
Excellent written, verbal, interpersonal communication, and presentation skills.
Able to earn and maintain the respect of employees, peers, and management while taking a stand or advocating a position that may be unpopular.
Thrives working in a team environment.
Microsoft 365 software applications and proven experience in using these to improve and automate processes.
Knowledge:
Knowledge and understanding of various BCBSA measurement programs such as MTM/LOS, FEP, and LDLA Program measures and guidelines
Knowledge and understanding of Company Operational processes including enrollment, claims processing and inquiries.
Knowledge and understanding of operational core systems, such as Facets, ERNIE, Availity, Nice InContact. Familiarity with Plan offered benefit programs, including ancillary products.
Familiarity with basic statistics and sampling methodologies.
Experience:
5 years progressive experience in positions that involve assessing data, drawing insights, developing conclusions, and reporting results. Example positions could include accounting, public accounting, internal auditing, or operational management).
1 year staff, team lead or project lead experience
Location:
This position is classified hybrid, which requires onsite work on Tuesdays and Wednesdays.
Education and Certifications:
Bachelor’s degree in accounting, Business, Finance or similar field
Professional licenses or achievements as plus, such as: Certified Public Accountant, Certified Internal Auditor, Certified Information Systems Auditor Certified in Healthcare Compliance.
Physical Demands:
While performing the duties of the job, the employee is frequently required to sit, use hands to finger, handle and feel, and talk, hear, and see. The employee must occasionally lift and/or move up to 5 pounds.
About Us
We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a diverse and caring team of supportive colleagues, and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.
Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association. We are an equal opportunity/affirmative action employer and do not discriminate on the basis of race, color, religion, national origin, gender, sexual orientation, gender identity, age, genetic information, physical or mental disability, veteran status, or marital status, or any other status protected by applicable law.
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