TPA Segment President

Highmark Health - Oklahoma City, OK

Full-time - Senior

Oklahoma City, OK

Insurance Carriers and Related Activities

About the position

This position is responsible for setting and executing the growth strategy for Highmark's TPA business. The role involves creating, hiring, leading, and coaching a team of professionals to maintain and grow the TPA business, including the successful execution of the Strategic Plan. Key responsibilities include growing membership, revenue, and margin, exploring potential mergers and acquisitions, and ensuring compliance with regulations. The position provides strategic leadership in developing objectives, policies, budgets, and operating plans for the TPA business, ensuring stability and direction to achieve growth and corporate goals.

Responsibilities

• Work with external partners (TPA's, Sales, Brokers, and Consultants) to deliver a viable and sustainable TPA business unit.
• Lead internal teams and business partners to complete project activities and deliverables on time and on budget.
• Define the TPA strategy and roadmap, overseeing the affiliation life cycle/implementation and ongoing support requirements.
• Further develop the pricing and staffing model needed for the business' ongoing success.
• Ensure all TPA operations are in compliance with BCBS Association requirements and state and federal regulations.
• Introduce and market new products/services by developing time-integrated plans with internal and external partners.
• Accountable for the appropriate mix of products, services, and solutions available to serve the TPA market.
• Develop an ongoing approach to grow market share.
• Serve as the point of contact for all TPA issues for resolution.
• Evaluate third-party partnerships and additional growth opportunities with internal business partners.
• Lead the development of an operation reporting structure and a health dashboard to track success and failures of operations.
• Lead the implementation of financial and operational strategy and communicate it to management.
• Develop and implement sales, financial, operational, and marketing strategies to respond to market conditions and demands.
• Review relevant financial information and make necessary adjustments.
• Create and execute growth and potential acquisition strategies.
• Approve financial reporting including monthly reports to COO.
• Respond to significant trends regarding sales, membership, vendors, commissions, product performance, expense variances, and other revenue fluctuations.
• Lead the development of the annual budget.
• Lead the development and implementation of technology and process improvements to reduce administrative costs and enhance capabilities.
• Lead an organization that deploys managerial and other staff resources effectively.
• Provide developmental and growth opportunities for direct reports and regular coaching and feedback.

Requirements

• 10 years of experience in Health Insurance Sales Management, Health Plan Operations, Provider Contracting or TPA Services.
• 7 years of management experience.
• Bachelor's Degree in Business, Healthcare Administration or a related field OR extensive management level experience in the private or public sector with a background in business and/or health management.
• State specific Producer License Life, Accident & Health are required or obtained within 45 days of hire.

Nice-to-haves

• Highmark or BCBS Experience
• Strong relationships with key external stakeholders (brokers/Consultants) in PA, DE, WV, NY and/or CA market
• Experience selling to large self-funded customers
• Marketing experience
• Extensive management level experience in the TPA sector or background in dealing with large self-funded clients.
• Master's Degree in Business Administration.

Benefits

• Health insurance coverage
• Dental insurance coverage
• Vision insurance coverage
• 401k benefit for retirement savings plan
• 401(k) matching benefit
• Paid holidays
• Paid volunteer time
• Flexible scheduling
• Professional development opportunities
• Employee discount programs