Full Job Description
Job Summary:
Prepares the system for new member enrollment by supervising the accuracy of translation of contractual information into data attributes, identifying issues and escalating as needed, and providing subject matter expertise for Group Setup related projects. Supports member satisfaction through triaging and handling standard member issues, applying member feedback to improve processes, and providing quality customer service through all communications with groups and members. Works with other teams (e.g., sales, benefits, underwriting) to ensure effective coordination and communication across areas. Ensures team members comply with relevant laws and regulations, supports a culture of compliance, and maintains compliance with the Collective Bargaining Agreement. Continuously monitors data and assesses team needs based on performance metrics.
Essential Responsibilities:
Minimum Qualifications:
Additional Requirements:
Prepares the system for new member enrollment by supervising the accuracy of translation of contractual information into data attributes, identifying issues and escalating as needed, and providing subject matter expertise for Group Setup related projects. Supports member satisfaction through triaging and handling standard member issues, applying member feedback to improve processes, and providing quality customer service through all communications with groups and members. Works with other teams (e.g., sales, benefits, underwriting) to ensure effective coordination and communication across areas. Ensures team members comply with relevant laws and regulations, supports a culture of compliance, and maintains compliance with the Collective Bargaining Agreement. Continuously monitors data and assesses team needs based on performance metrics.
Essential Responsibilities:
- Recommends developmental opportunities for others; builds collaborative, cross-functional relationships. Solicits and acts on performance feedback; provides team members with feedback; and mentors and coaches to drive performance improvement. Pursues professional growth; provides training and development to talent for growth opportunities; supports execution of performance management guidelines and expectations. Implements, adapts, and stays up to date with organizational change, challenges, feedback, best practices and processes. Fosters open dialogue, supports, mentors, engages, and motivates team members on collaboration. Delegates tasks and decisions as appropriate; provides appropriate support, guidance and scope.
- Supervises and coordinates daily activities of designated work team or unit by monitoring the execution and completion of tactical action items and work assignments; ensures all policies and procedures are followed. Aligns team efforts and standards, and measures progress in achieving results; determines and carries out processes and methodologies; resolves escalated issues as appropriate. Develops work plans to meet business priorities and deadlines; coordinates, obtains and distributes resources. Removes obstacles that impact performance; identifies and recommends improvement opportunities; influences teams to execute in alignment with operational objectives.
- Engages in coordination across teams by: working with other teams (e.g., sales, benefits, underwriting) to ensure effective coordination and communication across areas and team members; and guiding teams (e.g., sales, account management, case installation) on completing request forms, helping them comply with updated regulations, and providing subject matter expertise for market facing issue resolution.
- Reviews team performance data by: continuously monitoring data and assessing team needs based on data/performance/scenarios; and supervising the operational health of teams and opportunities for risk mitigation based on data.
- Supports member satisfaction by: applying feedback from members to improve Group Setup processes; triaging issues as they arise and handling standard issues in collaboration with other teams, staff, and direct reports; and providing quality customer service through communication with groups and members and mentoring team members to ensure delivery of high quality customer service.
- Ensures team compliance with regulations by: assessing whether guidelines, procedures, processes, and policies comply with regulatory changes in health care administration; ensuring compliance with laws and regulatory agencies and overseeing collection of information for internal/external audits and implementing post-audit corrective action plans; supporting a culture of compliance that expects staff to comply with internal controls and applicable laws and regulations as part of their daily work; and maintaining compliance with the Collective Bargaining Agreement.
Minimum Qualifications:
- Minimum two (2) years of experience in a leadership role with or without direct reports.
- Bachelors degree in Business, Health Care Administration, Operations Research, Public Health Administration, Finance, or related field AND minimum five (5) years of experience in compliance, financial insurance, health care administration, or a directly related field. OR Minimum eight (8) years of experience in compliance, financial insurance, health care administration, or a directly related field.
Additional Requirements:
- Knowledge, Skills, and Abilities (KSAs): Negotiation; Written Communication; Compliance Management; Maintain Files and Records; Union Partnerships; Advising and Managing Partners; Company Representation; Consulting; Corporate Partnerships; Stakeholder Management; Coordination; Incident Escalation; Key Performance Indicators; Managing Complexity; Project Management; Risk Assessment; Service Focus; Investigations Management; Member Service; Insurance Regulations, Policies, and Procedures; Insurance Contracts; Underwriting; Quality Improvement; National/Multi-~State Sales and Account Management; Systems Thinking; Business Acumen; Business Planning; Business Process Improvement; Risk Management; Data Entry; Computer Literacy; Accountability; Autonomy; Stress Tolerance; Insurance; Customer Satisfaction; Health Plan Operations
Job Information
Job Category:
Management
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