Company Statement
EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com.
Operations - Process Improvement Lead
Summary of Job
Direct and provide oversight for Operations process improvements; lead business initiatives/special projects, issue management and resolution that are specific to the success of EmblemHealth Operations. Liaise with Operational Leaders, IT, and other business stakeholders to develop action and/or project plans, derive and document business requirements and support the business throughout the process. Create, drive, and monitor progress of issue resolutions, initiatives, or projects; provide feedback and recommendations; compile and present results of analyses to appropriate parties; and develop and prepare meeting materials that monitor progress. Investigate shortfalls, issues, and complaints in current business processes. Ensure appropriate system and process changes are deployed as needed to ensure that the functionality delivered meets the intent of the business requirements. Evaluate and make sound recommendations to improve performance, including efficiencies that align with best practices. Analyze company processes and procedures; and recommend/develop process enhancement strategies in conjunction with Operations management. Directly support SVP of Operations on all initiatives and issue management, as required.
Principal Accountabilities
- Conduct research; gather data; use statistical and analytical techniques to identify potential issues and resolutions.
- Identify bottlenecks/obstructions to the completion of initiatives, projects/milestones; interface with business teams, IT leadership to remove barriers that slow or prevent the successful delivery of the project’s scope and objectives.
- Manage compilation, analysis and development of findings and recommendations with a particular emphasis on documenting issues (system, process, and people) and following through to complete resolution.
- Partner with Executive and line management to facilitate implementation of recommendations; facilitate follow-up.
- Drive development of business requirements and test planning and contribute as needed to document these requirements in alignment with other business stakeholders.
- Facilitate end to end communications, ensuring alignment of Operations team.
- Identify and support standardization and automation of process and workflow across all business where possible.
- Direct responsibility to track all efforts associated with assigned initiatives, including IT implementations/validations, workflow and process changes, training and effectiveness monitoring.
- Work with IT and Operations to highlight opportunities for improvement and monitor corrective actions to completion to ensure complete and comprehensive delivery.
- Communicate and collaborate with internal stakeholders as needed to support Operations objectives.
Qualifications
- BS or BA degree
- Project Management (PMI), Lean Six Sigma, or similar related certification preferred
- 5 – 8+ years of relevant, professional work experience
- Experience in Continuous Improvement Management for Operations
- Additional related specialized training/ experience/Project Management certification may be considered in lieu of Degree
- Energy, drive and passion for End-to-End excellence and customer experience improvement
- Excellent collaborative skills and the ability to influence management decisions
- Technical knowledge of health insurance claims/medical management/contact center/grievance and appeals systems
- Strong problem solving and analytical skills that be applied across all types of business problems
- Strong facilitation, oral and written communication, and presentation skills
- Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, etc.)
Security Disclosure
If you receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.
Pay Disclosure
At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.
EEOC Statement
We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.
Sponsorship Statement
At EmblemHealth, we are committed to building a diverse and talented workforce. However, we are unable to consider applicants who require, or are likely to require, either before or after hire, visa sponsorship for work authorization in the United States, including but not limited to H-1B, F-1 (STEM OPT), TN, or any other non-immigrant status. Some extremely rare exceptions may apply based on critical business needs.