Manager Operational Quality Control

Highmark Health; Pennsylvania; Hybrid; USD 79,000 - 127,000; Full time

Job summary

United Concordia Dental is seeking a senior leader to manage the Electronic Enrollment function and its team. The role oversees onboarding, file formats, transmission schedules, processing profiles, ID card design, testing, and production rollout.

The incumbent champions process improvement and uses new technologies, AI, and governance to enhance productivity, decision-making, and service delivery in a compliant environment. Travel may be required.

Qualifications

• Requires US citizenship and the ability to pass a background check.
• 3+ years of management/leadership experience.
• 3+ years of Electronic Enrollment experience.
• 3+ years of applying insurance principles and practices.

Responsibilities

• Oversee enrollment team operations and staffing.
• Lead hiring, coaching, and performance management.
• Ensure controls across the enrollment lifecycle and drive corrective actions to improve quality and client satisfaction.
• Promote innovation and operational excellence through emerging technologies and AI while maintaining governance and compliance.
• Foster cross-functional partnerships to enhance end-to-end processes and drive integrated solutions.

Skills

Team leadership

Cross-functional collab

Process optimization

Vendor collaboration

Documentation

Knowledge sharing

Leadership experience

Electronic Enrollment experience

Insurance principles

Education

High School Diploma or GED

Bachelor's degree preferred

Job description

Company : United Concordia Dental Job Description : JOB SUMMARY **Due to Department of Defense (DOD) contract requirements, the incumbent who fills this position must be a US citizen, and must also pass a background check** This leadership role is responsible for managing the quality, accuracy, compliance, and operational performance of the Electronic Enrollment function.

The position oversees a team responsible for implementing and maintaining electronic enrollment solutions, including client onboarding, establishment of file formats and transmission schedules, configuration of processing profiles, ID card layout development, business and technical testing, and production implementation.

The incumbent champions continuous improvement and promotes a culture of innovation and operational excellence by leveraging emerging technologies, process optimization methodologies, and responsible use of artificial intelligence to enhance productivity, decision‑making, and service delivery while maintaining appropriate governance and compliance standards.

ESSENTIAL RESPONSIBILITIES

• Perform management responsibilities to include, but not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.
• Plan, organize, staff, and manage the day-to day operations of the team; develop and implement policies and programs as necessary; manage to assigned budgets.
• The role ensures appropriate controls are maintained throughout the enrollment lifecycle and leads ongoing analysis of operational performance, root cause identification, procedural discrepancy resolution, and implementation of corrective actions to improve quality, efficiency and client satisfaction.
• This role promotes a culture of innovation and operational excellence by leveraging emerging technologies, process optimization methodologies, and responsible use of artificial intelligence to enhance productivity, decision‑making, and service delivery while maintaining appropriate governance and compliance standards.
• The manager fosters strong cross‑functional partnerships across Enrollment, Account Installation, Information Technology, Product, Claims, Customer Service and other operational areas to enhance end to end process knowledge, improve organizational effectiveness and drive integrated solutions to complex challenges.
• Through collaboration and knowledge share, the incumbent ensures alignment across teams and helps remove operational barriers that impact client and member experiences.
• Other duties as assigned or requested.

EDUCATION

• Required High School Diploma or GED
• Substitutions None
• Preferred Bachelor's Degree

EXPERIENCE

• Required Due to Department of Defense (DOD) contract requirements, the incumbent who fills this position must be a US citizen, and must also pass a background check
• 3 years of Management or Leadership Experience
• 3 years experience in Electronic Enrollment
• 3 years experience utilizing insurance principles and practices

SKILLS

• Builds engaged, high performing team through coaching, mentoring, accountability and empowerment.
• Connects upstream and downstream impacts to develop effective, sustainable solutions.
• Identifies opportunities to simplify processes, eliminate waste, and improve operational outcomes.
• Builds strong partnerships across departments and functions.
• Effectively collaborate with vendors, clients, and technology partners to identify soltuions, implement enhancements and improve service delivery.
• Promotes knowledge sharing and ensures processes are clearly documented, sustainable and accessible across teams.

Travel Requirement 0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-Based Physical work site required Occasionally

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees in this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum: $79,300.00 Pay Range Maximum: $127,100.00 Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

California Consumer Privacy Act Employees, Contractors, and Applicants Notice Highmark Health is a national, blended health organization that includes one of America’s largest Blue Cross Blue Shield insurers and a growing regional hospital and physician network.

Based in Pittsburgh, Pa., Highmark Health’s 35,000 employees serve millions of customers nationwide through the nonprofit organization’s affiliated businesses, which include Highmark Inc., Allegheny Health Network, HM Insurance Group, United Concordia Dental, HM Health Solutions and HM Home & Community Services. Highmark Health’s businesses proudly serve a broad spectrum of health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions.