VP HM Specialty Operations

Company :

HM Insurance Group

Job Description :

JOB SUMMARY

This job provides leadership in the development of short and long-range objectives, policies, budgets and operating plans for the HM Specialty organization of HM Insurance Group which includes underwriting, pricing, contract negotiation, sales and marketing, account management, claims, commissions, billing/premium collection and policy issue. Establishes the appropriate structure, supports and leads the culture and philosophy by which HM Specialty functions, and is accountable for the management and control of the Departments resources. Duties include, but are not limited to, working with the SVP of HM Specialty to design and implement business strategies; setting goals to optimize performance; overseeing daily operations of the Department; ensuring all activities relating to work are completed according to specifications and are compliant; leading and motivating employees to encourage maximum performance and engagement; and others. Directly responsible for the strategy and performance of HM Specialty, including pricing, underwriting, negotiation of contract terms, sales and marketing, account management of HM Specialty business and will oversee other functions - premium collection, claims payments, policy issue, and commissions, and related customer service activities, in multiple office locations as well as work from home staff. Additionally, provides direction for staffing, performance and training of departmental employees including coaching, consulting and mentoring leaders on complex issues related to the handling of any underwriting, claims and or customer service activities.

ESSENTIAL RESPONSIBILITIES

• Perform management responsibilities to include but are not limited to: involved in hiring and termination decisions, coaching/development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.

• Strategy Development: Partner with the SVP HM Specialty in the creation of the overall strategy and direction of HM Specialty, including key broker relationships and lines of business to target, and the structure of potential deals.

• Operations Oversight: Lead the development and implementation of technology and process improvements to reduce administrative costs, enhance customer satisfaction and enhance capabilities to enable growth in the respective markets.

• Will directly work on underwriting facultative approvals and will act as primary liaison for issues related to premium collection, claims, commissions, policy or contract issues.

• Claims: Monitoring and coordinating adjustments to internal and external developments in business segments and corresponding requirements; cross-functional support; monitoring monthly performance measures and addressing potential issues; meetings and calls with brokers and TPAs regarding claims issues/updates; review of exception requests; claims approvals per required MAR criteria; internal and external communications related to new developments and updates; monthly staff meetings with claims management; handle legal matters pertaining to claims payments, bankruptcies, etc.

• Cost Containment: review and approvals of preferred vendors for recommendations, approvals of subrogation settlements, develop and/or review E-blasts for updates on claims trends, market developments, and new treatments; monitor ongoing communications/meetings with TPAs and brokers; establish annual goal for scheduled reach-outs by Claims, Clinical and Pharma; regular meetings with Blues Partners to coordinate handling of potential and existing claims; monitor current process for necessary modifications.

• Premium Collections/Billing: monitoring and coordinating adjustments to internal and external developments in business segments and corresponding requirements; cross-functional support; monthly tracking of premium and enrollment, collections, and AR aging; approval of premium refunds via Billing system; staff meetings.

EDUCATION

Required

• Bachelor's degree

Substitutions

• None

Preferred

• None

EXPERIENCE

Required

• 10 years of utilizing insurance principles, industry practices, operational and system processes, quality control techniques, resource management and financial management skills

• 7 years in a management role in Reinsurance, Stop Loss, Healthcare, Insurance or Financial services with experience in driving change and process improvements

• 7 years of evaluating technology for implementation in gaining improved services and reengineering process and procedures

• 7 years in utilizing various industry laws and regulations such as ERISA, HIPAA, Sarbanes Oxley compliance, Act 68 and Act 147

• 7 years of presenting and communicating with large audiences, executives, board members and customers

Preferred

• Experience with Blue Cross Blue Shield

• Experience with sales and marketing

• Experience with HIPPA and Act 68

LICENSES or CERTIFICATIONS

Required

• None

Preferred

• None

SKILLS

• Communicate effectively, both written and verbal. Can adjust based on audience level

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office based

Teaches / trains others

Occasionally

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

Rarely

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

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

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 Companys Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employees responsibility to comply with the companys 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.

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, 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, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

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.

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Req ID: J209877