Manager - Operations (Quality Assurance)

Location

Mason, OH | United States

Job description

Requisition ID: 834664  
Position: Full-Time
Total Rewards:  Benefits/Incentive Information

There’s more to EyeMed than meets the eye. EyeMed is the fastest growing managed vision benefits company in the country with consistent double-digit membership growth! Through our commitment to innovation, we’re reimagining the way employers and their employees think about vision care. We want them to see life to the fullest and experience more of what’s best, not more of the same. And if what’s best hasn’t been done yet, it’s our exceptional and passionate employees driving this change. But, our passion for vision isn’t just about vision insurance benefits. Our employees are proud to support and participate in life-altering global and local missions through our partnership with OneSight, a leading not-for-profit organization with a 100% focus on eradicating the world’s vision crisis.

Your family says a lot about who you are. EyeMed is a key member of the Luxottica family of companies, global leaders in the design, manufacture and distribution of fashion, luxury and sports eyewear. In North America, Luxottica is the home to global brands Ray-Ban, Oakley and many top fashion house brands. Our leading retail brands include LensCrafters, Sunglass Hut, Pearle Vision, and Target Optical.

If you’re passionate about driving innovation and change and interested in a career in the optical and insurance industry, EyeMed wants to start the conversation and help provide you a growth-focused opportunity with America’s fastest growing vision benefits company.

GENERAL FUNCTION

The Manager – Quality Assurance is responsible for managing a team of Specialists that perform the case management process for EyeMed’s Grievance and Appeal (G&A) team. The Manager is responsible for quality advocacy, resource planning/management and resolution of issues that impact the quality, timeliness and productivity of grievance and appeals cases. The Manager is also responsible for analyzing performance trends over time and seeking continuous improvement and automation to increase efficiency and effectiveness of G&A case management. This position will support closure of escalated G&A case scenarios across Commercial, Medicare and Medicaid lines of business.

MAJOR DUTIES AND RESPONSIBILITIES

• Leads the G&A team by providing direction to a team of Specialists, giving guidance on cases, monitoring performance of direct reports and performing consistent quality management.
• Analyze team performance to ensure data integrity, compliance with department standards, identify process improvements, and communicate process changes to team and cross-functional partners.
• Accurately assesses strengths and development needs of associates and sets clear goals based on the associate’s individual strengths.
• Ensures G&A data standards, policies and desk level procedures are documented and current, ensuring appropriate controls & key compliance requirements are met.
• Monitor and drive Key Perfomance Indicators (KPIs) and proactively develop remediation plan when required.
• Leads the research and resolution of highly escalated grievance and appeal cases.
• Create and present reports to EyeMed leadership outlining performance relative to targets on a recurring basis, highlighting areas of risk and actions required to mitigate.
• Leads the research and resolution of highly escalated grievance and appeal cases.
• Regularly evaluates case handling to identify best practices in our templates, intake flow and provider reach outs.
• Partners with cross functional teams consistently on concerning complaint trends, client outliers and escalated matters, always considering root cause analysis.
• Identifies and implements improvements based on gathered data and feedback from G&A team.
• Promotes collaboration and the value of the G&A team being an insight point within the brand.

BASIC QUALIFICATIONS

• Bachelor’s degree or equivalent work experience
• 5+ years’ experience in healthcare industry / operations related position
• 5+ years’ experience in people management
• Ability to work under pressure and multi-task
• Analytical, critical thinking skills the ability to interpret data results to form action plans
• Strong communication skills

PREFERRED QUALIFICATIONS

• Experience supporting remote teams
• Working knowledge of operations of a Grievance and Appeals or Customer Service team
• Familiarity with NCQA guidelines and URAC standards
• Working knowledge of Excel, Facets, Cura, Filebound and SAP
• Experience in building and delivering executive presentations

Employee pay is determined by multiple factors, including geography, experience, qualifications, skills and local minimum wage requirements. In addition, you may also be offered a competitive bonus and/or commission plan, which complements a first-class total rewards package. Benefits may include health care, retirement savings, paid time off/vacation, and various employee discounts.

Upon request and consistent with applicable laws, EssilorLuxottica will provide reasonable accommodations to individuals with disabilities who need assistance in the application and hiring process.  To request a reasonable accommodation, please call the Luxottica Ethics Compliance Hotline at 1-888-887-3348 (be sure to provide your name and contact information so that we may follow up in a timely manner) or email [email protected]. 

We are an Equal Opportunity Employer.  All qualified applicants will receive consideration for employment without regard to race, color, gender, national origin, social origin, social condition, being perceived as a victim of domestic violence, sexual aggression or stalking, religion, age, disability, sexual orientation, gender identity or expression, citizenship, ancestry, veteran or military status, marital status, pregnancy (including unlawful discrimination on the basis of a legally protected pregnancy or maternity leave), genetic information or any other characteristics protected by law. Native Americans in the US receive preference in accordance with Tribal Law. 

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