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Kaiser Permanente Careers

Insurance & Claims

Delivery You Can Count On

As a member of our Claims Connect team, you'll help process and deliver the claims information Kaiser Permanente's members, providers, regulators, and customers need, and expect, from a world-class health care organization.

Operations Manager (Commercial Membership Admin) - COLORADO

Location: Denver, CO Job Number: 883815 Date posted: 08/24/2020

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Description:
The Product Operations job function is responsible for all product operational activities for both new and existing product lines and/or product categories where those products utilize an external vendor and/or internal vendor (as applicable). Responsibilities include development and management of the operational model, production environment and administrative activities for an existing product line and/or product category. The Product Operations job function may be responsible for oversight and management of insurance company transactional based functions (i.e. Claims processing, Customer Service, Billing/Eligibility, Large Claim Review program, various cost containment programs such as Hospital Bill Review and Third-party Liability).  Other Product Operations responsibilities may also include the management and delivery of certain regulatory functions (i.e. management of various jurisdictional regulatory required functions such as Special Investigative Unit, Grievance and Appeals Unit, Department of Insurance Market Conduct exams, submission of various regulatory filings).
The Product Operations job function is responsible for leading work throughout the product administration process. The job function will ensure the products being administered meet customer (e.g., member, broker, consultant, purchaser, internal customer, etc) needs and expectations relating to product operations and administration, as well as ensuring that products operate within applicable federal, state and local regulatory requirements.  The product and/or product line will also be managed to ensure that industry standard operational metrics are established (examples of success metrics include, budget targets, customer expectations, internal performance metrics, regulatory requirements, etc.), and the line of business operational targets are met or exceeded on a consistent basis.
The product operations role partners closely with other functions such as product development, product solutioning, compliance/regulatory, IT, strategy, Sales & Account management, training, operations and administration etc.
The Product Operation job function is also responsible and accountable for leveraging the applicable components of the Product Development and Management Process (PDMP) and Comprehensive Delivery Process (CDP).  The product operation function will provide input on the PDMP process to ensure the process is current and aligned with what it takes to develop and manage products in the current environment.

Essential Responsibilities:
  • Provides strategic direction to cross-functional (national and regional) areas to design, implement and manage moderate to complex administrative processes.
  • Manages cross-functional teams to lead the development of functional and feature enhancements to one or more product line.
  • Responsible for analyzing vendor & internal operational process metrics including variance analysis.
  • Uses knowledge of industry regulations to ensure compliant processes.
  • Identifies areas of improvements, and takes independent action to resolve gaps and enhance efficiency and effectiveness.
  • Sees connections between product and corporation strategy and operational excellence.
  • Responsible for gathering, collating and analyzing vendor & internal operational reporting, and provide variance analysis.
  • Negotiates and manages internal financial arrangements including recharge agreements.
  • May be responsible for ensuring the soundness of the product lines financial controls.
  • Accountable for regional engagements to ensures alignment between national and regional concerns.
  • May be responsible for business case development and multi-year planning.
  • Lead resolution of complex eligibility, claims, and customer issues.
  • Provides competitive insights and analysis.
  • Represents operations and provide subject matter expertise and vendor management for complex strategic and pilot initiatives.
  • Understands product line solution end to end, and develops strong internal partnership with key subject matter experts to ensure effective root cause analysis, administrative alignment and collaboration.
  • Basic Qualifications:
    Experience
  • Minimum ten (10) years experience in product operations, customer/vendor management, health insurance, health plan administration, benefit policy administration or related field.
  • Education
  • Bachelor's degree or four (4) years of experience in a directly related field.
  • High School Diploma or General Education Development (GED) required.
  • License, Certification, Registration
  • N/A

  • Additional Requirements:
  • N/A

  • Preferred Qualifications:
  • N/A
  • Primary Location: Colorado,Denver,Lowry Administration Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 8:00 AM Working Hours End: 5:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: NUE-PO-01|NUE|Non Union Employee Job Level: Manager with Direct Reports Job Category: Insurance / Claims Department: Commercial Membership Administration Ops Manager Travel: No Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

    External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.

    Learn About Insurance & Claims Careers

    Careers in Insurance & Claims

    Our insurance and claims teams are committed to meeting customer and member expectations when it comes to the timely and accurate processing of claims, while remaining in compliance with federal, state, and local laws, as well as regulations and rules. Make an impact as you contribute to the implementation of contemporary technology in areas such as claims quality, claims operations, business analysis, processing, configuration, reporting, and more.

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