Manager Operational Quality Control

Highmark Health•PA, Working at Home - Pennsylvania, PA

2d•$79,300 - $127,100•Onsite

About The Position

This leadership role manages the quality, accuracy, compliance, and operational performance of the Electronic Enrollment function. The manager oversees a team that implements and maintains electronic enrollment solutions, including client onboarding; establishing file formats and transmission schedules; configuring processing profiles; developing ID card layouts; conducting business and technical testing; and implementing production processes. The role ensures appropriate controls throughout the enrollment lifecycle and leads analysis of operational performance, root-cause identification, resolution of procedural discrepancies, and corrective actions to improve quality, efficiency, and client satisfaction. The manager promotes continuous improvement, innovation, and operational excellence, using emerging technologies, process optimization methods, and responsible artificial intelligence practices while maintaining appropriate governance and compliance standards. The position builds cross-functional partnerships across Enrollment, Account Installation, Information Technology, Product, Claims, Customer Service, and other operational areas. The incumbent helps improve end-to-end process knowledge, organizational effectiveness, and integrated solutions to complex challenges, while helping remove barriers that affect client and member experiences. The position is office-based, with the physical work site required occasionally and travel of 0%–25%. The incumbent must be a U.S. citizen and pass a background check due to Department of Defense contract requirements.

Requirements

High school diploma or GED.
Three years of management or leadership experience.
Three years of experience in Electronic Enrollment.
Three years of experience utilizing insurance principles and practices.
Must be a U.S. citizen due to Department of Defense contract requirements.
Must pass a background check.
Ability to build engaged, high-performing teams through coaching, mentoring, accountability, and empowerment.
Ability to connect upstream and downstream impacts to develop effective, sustainable solutions.
Ability to identify opportunities to simplify processes, eliminate waste, and improve operational outcomes.
Ability to build strong partnerships across departments and functions.
Ability to collaborate effectively with vendors, clients, and technology partners.
Ability to promote knowledge sharing and maintain clear, sustainable, accessible process documentation.

Nice To Haves

Bachelor's degree.

Responsibilities

Manage hiring and termination decisions, coaching and development, rewards and recognition, performance management, and staff productivity.
Plan, organize, staff, and manage the team's day-to-day operations; develop and implement policies and programs as necessary; and manage assigned budgets.
Oversee the team implementing and maintaining electronic enrollment solutions, including client onboarding, file formats and transmission schedules, processing profiles, ID card layouts, testing, and production implementation.
Ensure appropriate controls are maintained throughout the enrollment lifecycle.
Analyze operational performance, identify root causes, resolve procedural discrepancies, and implement corrective actions to improve quality, efficiency, and client satisfaction.
Promote innovation and operational excellence by using emerging technologies, process optimization methodologies, and artificial intelligence responsibly while maintaining governance and compliance standards.
Build cross-functional partnerships with Enrollment, Account Installation, Information Technology, Product, Claims, Customer Service, and other operational areas to improve end-to-end knowledge and organizational effectiveness.
Collaborate and share knowledge across teams, align work, and help remove operational barriers that affect client and member experiences.
Collaborate with vendors, clients, and technology partners to identify solutions, implement enhancements, and improve service delivery.
Promote knowledge sharing and ensure processes are documented, sustainable, and accessible across teams.
Perform other duties as assigned or requested.