Director, Service Operations

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. 

Effectively direct customer service and claims processing operations on a departmental/product/program basis to meet organizational and customer needs and applicable goals. Leverage key internal and external relationships to access the information, products and resources (technology, training, staff, etc.) necessary to successfully support the core activities of customer service and claims processing

Responsibilities:

• Direct departmental operations to ensure timely, consistent achievement of prescribed goals including but not limited to; departmental performance targets, divisional quality & production standards, key enterprise priorities, Service Level Agreements (SLAs) and Performance Guarantees (PGs).
• Hire, develop and retain high quality staff. This includes, but is not limited to; coaching & mentoring, evaluating job performance, providing meaningful, timely feedback and appropriately addressing performance issues.
• Manage departmental budget, including all salary and non-salary costs, within established guidelines.
• Leverage knowledge, experience, data and tools to forecast, prepare for and respond to changes in inventory and/or greater business need/climate.
• Champion process/ workflow improvements within or across departments/divisions.
• Develop/influence successful partnerships, interfaces and communications with key enterprise departments to drive goal achievement.
• Capitalize on existing technology, optimizing system capabilities. Identify and elevate opportunities to incorporate new technology into processes and workflows (especially manual processes and interventions).
• Lead high profile internal and/or external workgroups, presenting findings to appropriate leadership teams.
• May cultivate, drive and/or maintain critical, strategic business partnerships with; outside vendors, service providers (QBlue, NASCO), regulatory agencies (Department of Banking & Insurance, DOBI), the Blue Cross Blue Shield Association, and/or State/Federal Program administrators.•
• Accountable for maintaining effective internal controls over the processes and transactions under areas of responsibility including the completeness and accuracy of financial information and transactions, compliance with applicable laws and regulations, and the effectiveness and efficiency of operations.

Education and Experience

•  High School Diploma/GED required.
• Bachelor degree preferred or relevant experience in lieu of degree.
• Minimum of ten (10) years management experience required.
• Successful track record managing large staff groups (150+ FTEs) preferred.
• Knowledge of health insurance products required, experience directing health plan operations preferred.
• Experience managing in a fast paced, high volume, transaction-driven environment necessary.
• Call Center/insurance claim management experience preferred.
• Experience managing in a Union environment preferred

Knowledge:

• Requires familiarity with systems implementation, insurance terminology, and health plan operations

Skills and Abilities:

• Ability to manage multiple, dynamic work assignments and priorities, as well as diverse work/product teams.
• Ability to communicate successfully with all levels of management, including those at the highest level of the organization.
• Proven project management skills.
• Strong leadership, strategic problem solving, analytical and interpersonal skills.
• Exceptional written and verbal communication skills.

Travel:

• Min of 10% travel may be required

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

Salary Range:

$152,500 - $208,110

​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 equi