Network Service Manager jobs in Appleton, WI

Network Health's success is rooted in its mission to enhance the life, health and wellness of the people we serve. It drives the decisions we make, including the people we choose to join our growing team. Network Health is seeking a Enrollment and Business Analysis Integration Manager to lead our Enrollment team. This individual is responsible for directly managing our enrollment services, including but not limited to QNXT, myQNXT, Enrollment Administration Manager (EAM, Jet, integrity of 834 files), along with all I.S. eligibility and enrollment supported systems. The person in this role will help ensure Network Health best practices are in line with industry standards to support the business operations of the core systems and insurance functions. Core to the role will be leading and developing the Network Health Enrollment team based on best practices in requirements gathering process, storyboard/use case development, business/functional requirements management, and implementations.

This position is responsible for enrolling new groups and members for Commercial, HIX, and Medicare members. This will be accomplished through the development and implementation of ongoing strategies, procedures and best practices to continually enhance the level of service to members. The Manager will work with the Compliance Department to monitor new and/or changing rules, laws and regulations to understand current business practices and problems, recognize opportunities, research updates and changes impacting current business practices and make recommendations to help drive changes and assist the Department in achieving overall goals. Additionally, this role will partner closely with the quality assurance department to help drive changes that result in meeting quality goals.

Essential Job Duties

• Demonstrates commitment and behavior aligned with the philosophy, mission, values, and vision of Network Health
• Applies all organizational and regulatory policies, procedures and requirements. Ensures all audit requirements are met while performing routine auditing and reporting to support internal and external audit requirements.
• Performs human resource management duties including but not limited to recruitment, coaching, time and performance management, along with termination when required. Consults with leader and Human Resources as required. Performs ongoing assessment and develops resource strategies for staffing levels and the skill sets necessary to successfully accomplish project goals, quality expectations, specialized support and service levels.
• Provides support and leadership to department staff. Maximizes staff performance through regular team meetings, effective training, on-going 1:1 performance discussion, as well as formal performance review and meaningful development.
• Implements appropriate change management, data integrity and security policies and procedures, and monitors that associates comply.
• Identifies, adopts and improves existing and future technologies, efficiencies, processes, procedures and best practices to ensure the availability and responsiveness.
• Ensures a working Disaster Recovery plan is tested annually or no less frequently than is required by CMS or other regulatory bodies.
• Establishes, monitors, measures and reports on key quality and productivity metrics. Based on trend analysis, identifies action plans to optimize performance. Monitors productivity, accuracy and efficiency of operating systems as well as any issues that develop.
• Collaborates across the organization and leads the functional teams in setting project priorities, communicating progress of projects, requesting resources, and presenting necessary justification for new initiatives to support the core business
• Identifies, determines root cause and resolves operational problems and inefficiencies to ensure continued high-quality configuration and service to internal and external customers, and achieve required operational results
• Coordinates off-cycle and emergency requests to production, including user acceptance testing (UAT) and vendor support.
• Manages the relationships with third party application vendors such that there is a positive and professional working relationship and that SLA's are documented and met, for example Jet and Cognizant.
• Provides input representing business systems needs to the Operations strategy and planning process
• Accountable for all SLA/KPI's set by the organization for the Enrollment team, including but not limited to CMS and ETF.
• Other duties or responsibilities as assigned

Functional Skills:

• Excellent analytical, communication and organizational skills
• Strong leadership and management skills that align with our culture. Specific skills include facilitating change, driving operational excellence and striving for continuous improvement.
• Experience developing a team and strategy while building consensus with peers and executive leadership
• Active association and board participation, including but not limited to Health Plan Alliance and/ Cognizant user groups.
• Experience in reviewing development activities in troubleshooting SQL, SSIS and SSRS
• Ability to review, interpret and apply complex CMS regulations related to eligibility or claims processing requirements and HIPAA
• Ability to work in a fast-paced environment, deliver results with deadlines, and manage escalations and communications during critical outages and activities
• Advanced knowledge of technical specifications of QNXT or a related claims/eligibility system in table structures and functions and experience reading and analyzing release notes to determine impacts
• Experience in project management, including but not limited to, proficiency in organizing, resourcing and scheduling business requirement gathering and testing of development efforts
• Understands the complete impact of production deployments to other systems and customers
• Advanced understanding of relational databases, process design, software development life cycle (SDLC) and documentation methodologies
• Experience leading teams leveraging lean, scrum, or agile type of development methodologies
• Knowledge of testing methods, automation tools and documentation practices for defect tracking and resolution and the ability to create and implement a testing strategy for the organization
• Experience with IT services platforms like QuickBase or ServiceNow

Knowledge/Skills/Abilities Required:

• Continuous Improvement, leading the Organization by continuously striving to enhance products, services or processes to improve quality and efficiency.
• Leadership, leading others in achieving outcomes through people by successful objective setting, performance review, motivation, delegation, relationship building, empowerment and valuing diversity and difference to provide environment of development and teamwork.
• Positive Conflict Management, leading others in viewing conflicts as opportunities; reading situations quickly and utilizing focused listening; managing tough agreements and finding common ground and resolution.
• Results Driven, focusing on the desired result of one's own or department's work, setting challenging goals, focusing effort on those goals, and working towards achieving tangible results while showing persistence in the face of obstacles.
• Interpersonal Awareness & Approachability, leading others to process the awareness of others by noticing, interpreting, and anticipating others' concerns and feelings, and communicating empathetically. Leading others to be at ease with building rapport with employees by being approachable, easy to talk to and a good listener.
• Change Management, leading the Organization by demonstrating support for innovation and organizational changes needed to improve the organization's effectiveness by planning, implementing and influencing others to successfully manage change.
• Communicating Requirements Skills, including the use of presentation skills and the ability to create a requirements package.
• Collaboration, leading the organization by working together within one's team and with teams across the organization towards common goals.

Minimum Education Required:

• Requires BS in Computer Science, Business or related technical field. Relevant experience may be substituted for formal degree work at a rate of 2 years' experience for each year of formal degree work.

Minimum Related Years of Experience (per minimum education) Required:

• 6 years of experience in Information Technology
• 9 years of experience in health insurance required or healthcare related field required
• 9 years' experience working with QNXT software required; experience with Cognizant, Optum or similar software preferred
• 9 years of experience working in a configuration, EDI or business analysis role required
• 4 years of leadership or mentoring required
  
  
  

Candidates must reside in the state of Wisconsin for consideration. This position is eligible for our hybrid workplace model to work at your home office (reliable internet is required), and at our office in Brookfield or Menasha.

Network Health is an Affirmative Action & Equal Opportunity Employer. We encourage applications from all backgrounds, communities and industries, and are committed to having a team that is made up of diverse skills, experiences and abilities. We are committed to equality and diversity within Network Health.

Network Health is a DiversityJobs Employer Member for our commitment to diversity in the workplace.

*WARNING: Please beware of phishing scams that promote work-at-home opportunities and which may also pose as legitimate companies. Please be advised that Network Health recruiter will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for a role with our company. All of our positions require that you first complete an online application.