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Program Manager of Network Administration - (Role Number: 192364)

05/10/2018Call Center
Job Location:
Green Bay, WI
Metro Area:
WI - Green Bay
Company Name: Humana Inc.
Website:  Click to Visit
Role: Program Manager, Network Administration

Assignment: Group & Specialty Service Operation 

Location: Louisville, KY; Green Bay, WI; Cincinnati, OH

 

Assignment Capsule

 

The Program Manager, Network Administration will work closely with Provider Network and Network Administration teams as well as Specialty Operations to lead the process design, process improvement, process transformation, and process quality control efforts originating from or impacting Network Administration. 

 

Network Administration is pivotal to internal dental claims processing as well as impacting provider operations and other areas.  The team is in the midst of system migration and critical system enhancement projects needed to support the large scale work within the Dental Network Administration team and directly impacting the growth of the dental provider network in support of the specialty membership growth strategy. 

 

The Dental Network Administration team is responsible to load provider and rental network data, complete provider demographic and/or contract systems updates in a compliance driven environment - which ultimately sets the accuracy of the dental provider directory.

 

The Program Manager will have a specific focus on improving the provider and associate experience by setting strategy and leading and providing project support to complete the work that simplifies processes, drives automation of high volume transactions, coordinating work between Humana teams to maximize resource effectiveness.  Specific responsibilities include but are not limited to the following:

  Process Mapping and flow, including identification of controls

  Root cause analysis identify gaps in processes, redundancies, inefficiencies and potential for defects

  Coordination with other GBO services  (ex: Dental Provider Call Center on call drivers due to network administration data errors)

  RACI development and various Network Administration documentation

  Process improvement and Corrective action partner with the Continuous Improvement GBO team, with specific technology partners, and others, to implement corrective actions and process improvements

 

Key Responsibilities

  Demonstrate a comprehensive understanding of the relationship between business needs and analytics/technological solutions.  Includes comprehensive end to end understanding of the provider data entry process, and downstream data feed process and interrelations with applications which use this data.

  Close process performance gaps through dental network data entry process streamlining, cycle time reduction and identification/elimination of quality issues, process variation and non-value add activities

  Resolve issues that threaten success, whether in terms of turnaround time, compliance, or quality, or in general team productivity and satisfaction

  Understand the impacts of change on the system (ex:work in this area can drive impacts to Provider Network, Claims, and Enrollment)

  Implement a plan to improve productivity through automation, process simplification, with measurable outcomes

  Use inquisitive, forward looking, big picture thinking to improve processes and business outcomes

  Drive interconnection between disparate projects to assure simplicity and data integrity

  Influence others to gain support for initiatives or changes that will improve business outcomes; facilitate productive relationships with other analytic centers, technology and operations departments.

  Focus on continuous improvement opportunities within the Specialty Network Administration team or other areas of the organization to reduce provider complexity.

  Establish solid relationships with all business groups in order to influence and understand on-going business needs. Identify potential improvements in processes and then develop and implement new procedures needed to support changes, efficiencies and expense reduction in the business.

 

Key Competencies

 

Customer-Valued Solutions

Knows the customer and what they value. Listens to the customer, focuses on their needs and uses a systems-view to identify potential Humana solutions. Designs solutions for customers' current and future needs and follows-up to ensure solutions exceed expectations. Articulates the value Humana provides in the customer's language, making the complex simple.

 

Process Design & Development

Applies process-based methodologies to developing new processes, optimizing existing ones, and identifying ways to enhance efficiency. Leads the execution of a process to achieve specific outcomes and makes connections across processes to meet common goals.

 

Acts Strategically

Sees how decisions can impact the whole of the organization and makes decisions using a broad knowledge of the long-term vision, values, and strategy of the organization. Uses an enterprise-wide perspective to translate strategies into actions, creating a clear view of the future state. Inspires others to embrace and advance the strategy as it evolves and is realized.

 

Leads Change

Models agility, adaptability and openness to new ways of thinking and operating. Guides and energizes others to embrace new opportunities arising from change. Inspires strong organizational performance through periods of transformation, ambiguity, and complexity.

 

 


Role Essentials  
  • Bachelors degree or 5+ yrs of related exp in lieu of degree.
  • Experience driving improvements in a Lean, Six Sigma, or other process improvement environment
  • Proven ability to lead, facilitate, prioritize, negotiate, problem solve, and inspire team members in a matrixed environment
  • Ability to manage time and workload to prioritize projects and tasks to ensure appropriate allocation of resources
  Role Desirables
  • Six Sigma credentials (ex.: Black Belt)
  • Advanced degree
  • Ability to translate requirements between business and IT to drive technical investments
  • Minimum of 3-5 years identifying, prioritizing, managing and delivering complex, large scale, cross-functional projects or programs
Reporting Relationships This role will report to a Director of Group Service Operations, under the leadership of the Segment Vice President, Group Business.  
 
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