I am recruiting to fill three positions for a large integrated healthcare system and Health Plan client. There are currently openings for
who will be tasked with driving a Program to re-structure the entire California Claims and Encounter strategy for my client, working under the direction of an Executive Director of Business Architecture. The title of the positions will be "Business Architect". These are full-time, permanent positions and the initial project is projected to take five years to complete.
All potential candidates should have a thorough understanding of Claims and Encounter operations, systems and processes in a managed care environment. The three Business Architects will each have a concentrated area of responsibility:
Here is a general job description that describes the general task for all three of these Team Leaders:
Major Responsibilities
1. Leads team to establish strategic plans and objectives for the Program; assists with developing cross-functional oriented objectives.
2. Define business solutions and structures needed to realize end-state vision and opportunities. Will be the organization’s expert in defining optimal business processes and system architectures.
3. Influences the development of solutions and defines the scope of work for the Program.
4. Assists with defining the performance goals and metrics for the proposed solution and evaluate the impacts on the business.
5. Serves as a liaison to the business community to ensure needs are fully understood by the Program. requires major interaction with senior and executive leadership.
6. Assess Company’s current claims and encounter capabilities and define opportunities to create business value by analyzing upstream, in-stream and downstream processes.
7. Requires continuous collaboration and rigorous implementation of formal business process and system development planning methodologies, including design for six sigma, failure mode effects analysis, use case scenario modeling and regression test analysis.
Job Criteria
Business Impact
• Actions and decisions affect virtually all areas of Program.
• Uses understanding of complex internal and external variables to formulate work unit strategy (3+ years) in support of organizational strategy.
• Develops long term strategies and balances resources across a market/service area specifically designed to enhance member/customer satisfaction.
• Responsibilities impact the integrated achievement of functional and/or company objectives, that strongly contribute to longer term success or failure.
• Must ensure that all work-stream solutions are in alignment throughout the value chain and are not sub-optimizing other processes or the goals and objectives of the co mpany, as well as have a long term effect on company’s success.
• Consistently supports compliance and the POR by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non compliance, and adhering to applicable federal, state and local laws and regulations, accreditation and licensure requirements (if applicable), and the company’s policies and procedures.
Problem Solving
• Manages the resolution of diverse and complex issues where analysis of situations or data requires an in depth knowledge of multiple functions and company’s objectives.
• Takes calculated risks after making fact-based decisions to improve organizational performance. Tracks and measures results against external best practices.
• Requires experienced business or technical judgment to create novel solutions for thought provoking, diverse and highly complex issues.
• Analyzes recommendations made by others to solve issues bearing broad or company wide impact.
• May involve the application of sophisticated methodology.
Decision Making
• Involves the highest degree of interpretation and management of obscure or inconclusive data.
• Ability to see and understand end to end processes, cross boundary dependencies and “down stream" effects.
• Uses understanding of key business goals and strategies to make decisions that address key business threats and opportunities.
• Has final authority to make most decisions, except for those that require additional management approval.
• Decisions are commonly precedent setting.
• Uses understanding of the vision for Company to ensure that all actions taken within the regions are aligned.
Interactions/Communications
• Regularly interacts with senior or executive levels on matters concerning several functional areas, regions, and/or business partners.
• Builds organization wide relationships to move initiatives forward and positions ideas to enhance likelihood for success.
• Tailors communication style to engage audience and convey the rationale for decisions. Translates aspirations and strategy into action steps and creates commitment to the plan.
• Interactions normally involve controversial situations, negotiations, or influencing other senior management.
• Requires the persuasion, presentation and/or negotiation of functional strategies, philosophies, policies and/or opinions in order to substantially impact the function and/or areas of the Company
• Discusses and presents information and issues internally and externally and potentially controversial issues within the companies various business lines..
Independence/Discretion
• Exercises considerable latitude in determining objectives and approaches to assignments.
• Review of operational results and impact would be at the executive level.
Compliance Accountability
• Consistently supports compliance and the Princ iples of Accountability (Company’s Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state and local laws and regulations, accreditation and licenser requirements, and Company policies and procedures.
Management of Staff
• Provides managerial responsibility through multiple levels of management.
• Strategically builds a diverse employee base and creates services to enhance ability to serve diverse local populations.
• Accomplishes results through subordinates, who exercise significant latitude and independence in their assignments.
• Develops performance requirements.
• Has budgetary responsibilities.
