Sr. Manager Payment Integrity Strategy and Operations

Posted Yesterday
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5 Locations
In-Office
102K-184K Annually
Senior level
Healthtech • Insurance
The Role
This role involves leading process improvement initiatives, supporting team activities, analyzing results, and managing projects within health care operations.
Summary Generated by Built In

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

This Position Is Responsible For Leading The Process Leaders/Process Stewards In Planning, Defining, Developing, Testing, Documenting, Analyzing Results And/Or Implementing Process Improvement And Process Reengineering Opportunities. Leading And Supporting Business Process Activities And Methods To The Super Process Leaders/Process Steward. Leading Team Activities, Deliverables, And Issue Resolution. Leading Key Activities Including Data Collection, Metric Definition And Analysis, And Root Cause Analysis. Supporting Development And Evolution Of Hcsc Business Process Management Methodology Identifying Best Practice Standards, Guidelines, Procedures And Tools For Analyzing, Designing, And Implementing Business Process Initiatives. Ability To Travel.

Job Requirements:

  • Bachelor’s degree and 8 years of experience in health care quality improvement, health care accreditation, health care operations, or combination thereof OR 12 years of experience in health care quality improvement, health care accreditation, health care operations, or combination thereof, including 8 years of experience in the health insurance industry with large, multi-state payer(s).
  • 3 years of leadership or management experience.
  • Experience with Continuous Quality Improvement (CQI) concepts, Strategy, and Change Management concepts.
  • Experience with external accrediting agency requirements (i.e., NCQA, URAC, AAAHC) and history of success in achieving accreditation.
  • Experience providing support to senior-level staff in process re-engineering and strategic problem-solving.
  • Analytical skills and negotiation skills.
  • Verbal and written communication skills including leadership skills, organizational skills and detail-orientation, interpersonal skills, consensus building skills, professional presentation skills and decision-making skills.
  • Experience preparing documentation for auditors or project management
  • Knowledge and understanding of the health care industry and regulatory requirements.
  • Experience writing policies and procedures.
  • Written and verbal communication skills.
  • Ability and willingness to occasional travel.

Preferred Job Requirements:

  • Payment integrity operational processes and strategy

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees.  Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range$102,000.00 - $184,300.00

Exact compensation may vary based on skills, experience, and location.

Skills Required

  • Bachelor's degree and 8 years of experience in health care quality improvement, accreditation, or operations
  • 12 years of experience in health care operations, including 8 years in health insurance
  • 3 years of leadership or management experience
  • Experience with Continuous Quality Improvement (CQI) concepts
  • Experience with external accrediting agency requirements
  • Analytical skills and negotiation skills
  • Verbal and written communication skills
  • Experience preparing documentation for auditors or project management
  • Knowledge of the health care industry and regulatory requirements
  • Experience writing policies and procedures

Health Care Service Corporation Compensation & Benefits Highlights

The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Health Care Service Corporation and has not been reviewed or approved by Health Care Service Corporation.

  • Retirement Support A pension plan alongside a matching 401(k) is offered, an uncommon combination in the private sector. This combination is described as a standout element that helps retain employees.
  • Healthcare Strength Healthcare options are broad, with multiple medical, dental, and vision choices, wellness incentives, and access to resources like on-site fitness centers and an EAP. These offerings add meaningful value beyond base pay.
  • Parental & Family Support Paid parental leave (up to six weeks at full pay after one year), adoption assistance, and mothers’ rooms are available. These supports reinforce family needs alongside work commitments.

Health Care Service Corporation Insights

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The Company
HQ: Chicago, IL
13,563 Employees

What We Do

Imagine Something New, Something Different. Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), is the largest customer-owned health insurer in the nation and the fourth largest overall. Operating through our Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma and Texas (as well as a variety of affiliates and subsidiaries,) we are expanding access to high-quality, cost-effective health care. We are equipping members with information and tools so they can make the best health care decisions for themselves and their families. HCSC is continuously recognized as an employer committed to community, diversity and inclusion, training and development. HCSC is committed to pioneering the health care space in ways as effective as they are creative. If you are passionate about the impact you want to have through your work, with a desire to apply innovative thinking to new and emerging challenges, we encourage you to learn more about HCSC. Learn about what we stand for, how we work and the difference we’re making in the lives of our 15 million members. Join HCSC and discover what new ways of thinking can mean for you, your community, our customers and our organization. Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.

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