Dir, Operations, Braven Health

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey's health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.

Responsibilities:

• Actively participates in the creation and execution of multi-year business plans and operating model.

• Develop business cases and maintain a project portfolio and roadmap for Braven Health.

• Identify and prioritize implementation and process improvement programs or projects that markedly move us towards operational excellence, repeatability, and scalability, including projects with a focus on improving member experience and retention.

• Conduct portfolio reviews with management team and ensure business owners are appropriately engaged and informed.

• Maintain effective communication with senior leadership (EVPs, SVPs), making them aware of portfolio status, critical risks, and issues.

• Foster collaboration between operational departments, leadership, and vendors to support improvements in operational and financial performance.

• Support annual product and go-to-market strategy, bid submission, and benefit implementation.

• Develop playbooks for a repeatable, consistent, and well-documented approach to industry-standard programs.

• Develop and maintain dashboards, scorecards, and tools that provide actionable insights into key performance indicator(s) for the Braven Health management team.

• Review externally facing Braven Health materials for accuracy and consistency.

• Identify opportunities for enhanced Braven Health education and training across operational teams and collaborate with Training Department to develop material.

• Use a data-driven approach to identify, escalate, and remediate critical risks and issues proactively.

• Conduct post-mortem exercises following project completion and monitor action plans to address challenges.

Measures may include:

• Observation

• Review of PM Plans/Appraisals

• Solicited and unsolicited staff feedback

• Employee satisfaction results

• Report on late Performance Appraisals

Education/Experience:

• High School Diploma or GED required.

• Bachelor degree preferred or relevant experience in lieu of degree.

• Requires a minimum of 10 years of experience working for a Medicare Advantage plan.

• Experience in Medicare Claims, Service, Enrollment, Grievances, Appeals, Clinical/Utilization Management, Finance, Stars, and Revenue Optimization preferable.

• Experience managing budgets.

• Strongly prefers experience in leading cross-divisional teams on new programs and business development opportunities.

Knowledge:

• Knowledge of project management methodologies, tools, and practices.

• Requires knowledge of the health insurance industry.

• Requires knowledge of strategic planning concepts.

• Experience with Medicare Advantage required.

• A deep and broad understanding of the MA program and regulations.

Skills and Abilities:

• Requires strong project management skills.

• Requires creative thinking and problem solving skills.

• Must be self-motivated.

• Requires strong leadership skills.

• Requires strong organizational skills and the ability to manage multiple priorities and deadlines.

• Requires excellent PC skills and the ability to effectively utilize project management software.

• Requires proficiency in Microsoft PowerPoint and Excel.

• Requires excellent oral and written communication skills.

• Requires excellent conflict resolution and negotiation skills.

Special Licenses and Certifications:

• PMI Certification or completed course work toward PMI Certification preferred but not required

Core Competencies:

• The target competency level for the PROFESSIONAL role is "Applying" for the following core competencies.

• Analytical Thinking

• Business Savvy

• Managing Change

• Multidirectional Communication

• Service Quality

• Leadership

• Speed and Agility - Team Work - Technology Proficiency

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Salary Range:

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement

Disclaimer:
This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.