PMA Companies provides risk management solutions and services in the U.S., specializing in workers’ compensation, and offering property and casualty insurance. Headquartered in Blue Bell, PA, PMA has over a century of successful business experience.
Directly report to the Vice President, Managed Care Services. Lead efforts focused on identifying, scoping, and prioritizing continuous improvement projects that align with VP Managed Care business strategies. Serve as a project manager to lead the Managed Care team through the execution of all Managed Care product refinements and new product development. Responsible for the management and maintenance of the vendor registration & procurement process. Serve as a dedicated resource to internal business partners to support customer service and sales objectives to include client handling instructions, training and grievance resolution.
* Provide project management on all Managed Care product development and product risk assessments. Ensure project goals (e.g., deadline, scope and quality) are achieved. Assists with problem resolution or risk mitigation as needed to support Managed Care and all business partners.
* Apply project management techniques to ensure on-time, high-quality deliverables.
* Assume full end to end program delivery of solutions with focus on processes, people and systems.
* Provide periodic status reports to management which may include milestone achievement, financials, resource needs, and progress on deliverables, risks and issues. Confirm the Customer Success/Acceptance Criteria are fulfilled and met
* Establish/Maintain Standard Operating Procedures (SOP) / Best Practice Processes to be leveraged across external Customer and internal PMA entities. Leverage improvement tools to provide optimal Customer value.
* Lead efforts focused on identifying, scoping, and prioritizing continuous improvement projects that align with VP Managed Care business strategies.
* Recommend improved, strategic, measurable and sustainable solutions as well as identify further opportunities for improvement.
* Responsible for the Managed Care vendor registration and maintenance of market intelligence for all managed care service entities. Work directly with Manage Care product leads in the RFP/RFI process for vendor procurement.
* Identify and evaluate emerging trends opportunities and risks associated with changes in direction of external environment. Mainetance of database.
* Partner with Compliance and QA Specialist to ensure that appropriate documentation, implementation and communication of established policies, procedures and operating standards is completed.
* Monitor and evaluate activities to identify potential risks and issues of non-compliance.
* Participate in risk assessment and escalate potential issues to higher management
* Assist VP, Managed Care with the development of business tactical plans, forecasts for financial goals.
* Responsible for all RFPs, due diligence for all programs. Serve as direct liason with all business partners on the establishment of new accounts and and transition of lost accounts.
* Bachelor's Degree preferred and/or relevant experience.
* Expert knowledge of managed care products utilized within multiple insurance lines of business and posses the ability to assess the financial and operational impact.
* Experience in the preparation, management of RFP process, and in performing due diligence in network and product.
* Prior experience working collaboratively with cross-function business units to launch, implement, and evaluate projects.
* Demonstrated management and leadership skills with a proven track record of successful group dynamics and interpersonal relationships.
* Strong analytical skills are required with the ability to solve complex problems.
* Prior experience establishing and maintaining a quality management processes.
* Effective communication skills with demonstrated interpersonal skills, having the ability to influence and direct both verbally and in written communications with internal and external parties on a wide variety issues.
* Working knowledge of Microsoft Office Products such as Excel, Access, etc.