JOB TITLE: BPO Manager
DEPARTMENT: Health Plan Operations
REPORTS TO: Head of Operations
This position is responsible for overseeing the functions of the Health Plan Operations (aka: BPO) department: claims processing, utilization management, enrollment services, configuration, premium billing, quality assurance, and electronic data interchange for the Company's Health Plan customers; evaluating, analyzing, process creation, and reporting on key performance indicators (KPIs) to service levels, expenses, and value creation; acting as a key contact, bridging communication and process rollouts between the Company and our outsourcing and automation partners.
DUTIES AND RESPONSIBILITIES:
- Creates value and capacity across multiple business units through the leveraging of outsourcing, process optimization, and automation.
- Sets relevant and meaningful Service Level Agreement (SLA) goals for each responsibility outsourced and/or automated, and actively manage our partners to meet and exceeding those goals.
- Creates and develops meaningful and measurable KPI targets for the BPO team, and ensures set targets met or exceeded.
- Effectively communicates across multiple levels of management, vendor contacts, and key stakeholders in various support areas.
- Serves as subject matter expert on fulfillment of BPO team tasks in support of internal and external business partners.
- Ensures adherence to policies and governance best practices through creation, updates, and communication of Standard Operating Procedures (SOPs) and process flows for the BPO team.
- Transits new tasks and work types to our BPO vendor, using project management techniques to ensure new tasks are implemented on time and to required specifications.
- Acts as a primary point of contact with business users for changes, issues, and communication regarding outsourced and automation performance.
- Communicates regularly with outsourcing and automation partners regarding performance, feedback and efficiency opportunities.
- Leads regular performance review calls with stakeholders and business partners.
- Serves as an escalation source to help resolve issues for, or on behalf of the customer.
- Coordinates with business partners to deliver operational efficiencies and solutions through effective business processes.
- Ensures adequate quality controls are in place and performs root cause analysis when quality issues occur.
- Utilizes all available data points to clearly evaluate performance, identify problem areas, and communicate results to key stakeholders.
- Manages members of the BPO team, and ensures consistency and partnership from them in their interactions with business stakeholders and vendors.
- Provides appropriate channels for exception routing, query resolution, and business feedback.
- Prepares process maps, procedure manuals and conducts training with BPO vendors.
- Works directly with internal business units to build and review operational support materials as required by the various product lines.
- Stays abreast of latest technologies and providers in the BPO space to continuously deliver value and efficiency to the company.
- Implements and trains on policies, procedures and service standards for business operations.
- Hires, coaches, trains, and develops subordinate staff.
- Assigns work, sets completion dates, reviews work, and manages performance in accordance with organizational policies, procedures, and performance management processes.
- Provides guidance and technical advice and is actively involved in continuous improvement efforts.
- Provides leadership of assigned departments through subordinate staff.
- Analyzes budget variances and participates in the development of the team’s annual financial planning and monthly forecasts.
- Performs other related duties as assigned by management.
- Bachelor's Degree (BA) from four-year college or university, or one to two years of related experience and/or training, or equivalent combination of education and experience.
- Computer skills required: Healthcare Payer Solutions Software; Healthcare Claims Processing Software; Microsoft Office Suite; Project Management Software
Other skills required:
- 5 years’ experience in Business Process Outsourcing (BPO) and/or Business Process Engineering required with relevant experience in Healthcare, Insurance or Financial services preferred.
- Experience in Vendor Management and transitioning of functions to an outsourcing partner, as well as evaluating performance and managing vendors to contracted SLAs.
- Experience communicating performance, value, and efficiency metrics to multiple business stakeholders.
- Experience managing implementation of Robotic Process Automation (RPA) solutions is a plus.
- Ability to travel.