At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it's why our employees consistently vote us one of the "Best Places to Work in PA." The Program Operations Consultant is a customer-facing role with primary responsibility for the oversight, management and enhancement of Capital's consumer programs, including value-add products, services and consumer tools. This individual, who will possess strong relationship management skills, is required to lead and coordinate the efforts of cross-functional support teams consisting of individuals with diverse levels of knowledge from throughout the organization and will use creativity and initiative in providing solutions which meet or exceed the objectives of Capitals' product strategy.
The Program Operations Consultant serves as a liaison between the consumer program vendor partners and key operational areas within Capital BlueCross, such as Clinical Solutions, Operations, IT&D, Sales Support, Customer Service, and Sales. In this role, the Consultant is responsible to continually evaluate, develop and implement enhancements, improvements and innovative solutions to our value-add consumer programs to address our business needs as well as the needs of the market.
Manage Capital's consumer programs using a matrix team environment; coordinate activities between and among various members of the team, including Product Owners, Clinical Solutions, Operations, Marketing, IT&D, Actuarial Operations, Sales Support, Customer Service and Sales. Continually evaluate, develop and implement enhancements and improvements to policies, procedures, processes and tools related to the various programs. Develop, report and manage the contractual, business and key performance metrics to ensure successful program performance. Identify business issues associated with the consumer programs, develop options for resolving the issues; determine feasibility and associated cost/resource impacts, recommend solutions, and escalate issues to Management as appropriate. Collaborate with the Product Innovation team to help shape each program's long-term strategy and drive short term priorities; develop and maintain a consumer programs and tools roadmap. Assess new and pending legislation to determine impact on Capital's various consumer programs; ensure compliance with all legal and regulatory requirements. Maintain an understanding of market trends and opportunities as they relate to value-add programs and consumer tools. Provide support to the Sales Team, as needed, when promoting Capital's value-add consumer programs to potential customers. Serve as the liaison between Capital and our consumer program vendor partners Skills: Strong leadership skills; ability to build effective relationships; excellent communication and decision-making skills Demonstrated ability to work cross-functionally and manage teams in a matrix reporting environment Ability to translate business needs into a comprehensive action plan and take the lead in the execution of the plan. Strong project management skills and proven track record of successfully managing the implementation of major initiatives. Proven ability to manage multiple projects and priorities and to adapt to changing workload requirements while under deadline pressure. Exceptional communication skills, both written and verbal. Knowledge: Strong knowledge of the healthcare industry and demonstrated understanding of products, benefits, delivery systems and regulatory requirements. In depth knowledge of health plan operations, including sales, marketing, enrollment, billing, underwriting, claims, customer service and web services. Experience: 5 years of progressively increasing leadership experience in a corporate environment or additional 9 years of experience in lieu of degree. Demonstrated experience in successful execution and delivery of results; including ability to set goals, establish processes, meet deadlines and deliver expected outcomes with an appropriate sense of urgency Experience in applying project management tools/methodologies, and in planning, organizing, and managing major activities. Experience leading diverse workgroups/teams to successfully meet established objectives. Education and Certifications: Bachelor's degree or additional 4 years of experience in leiu of degree. Physical Demands: While performing the duties of the job, the employee is frequently required to sit, use hands to finger, handle and feel, and talk, hear, and see. The employee must be able to work over 40 hours per week. The employee must occasionally lift and/or move up to 5 pounds. We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a diverse and caring team of supportive colleagues, and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career.
And by doing your best, you'll help us live our mission of improving the health and well-being of our members and the communities in which they live.
