Director, Health Engagement & Operations Excellence

WHO WE ARE:

With the Health Division youll be joining a passionate team of self-motivated change agents united by our mission: driving to design the delivery of high-quality healthcare for nearly three-quarters of a million active and retired Texas public educators. The healthcare industry is complex and were a team of problem-solvers who are up for the challenge. With a focus on innovation and collaboration to catalyze the market we spend more than $4 billion annually on healthcare to make a difference in our members lives. With a career at TRS youll be empowered through a culture of continuous learning front-line decision making coaching and mentorship to shape the future of our work while transforming healthcare delivery for 1 in 41 Texans.

The Director of Health Engagement & Operations Excellence is responsible for the strategic planning and management of the Health Operations & Engagement department. The incumbent will oversee the Health Operations Excellence and Engagement teams ensuring effective communication and compliance with health plan regulations overseeing training quality assurance and process improvement initiatives manage program administration vendor contracts and provides technical guidance. This position will proactively work with Health Operations staff TRS Health Division leadership agency employees school districts and active and retired educators and their families.

WHAT YOU WILL DO:

Department Management
Oversees planning organizing implementation and monitoring all activities regarding the development of internal processes policies and procedures training program quality audit program and process improvement across the Operations department.
Oversees the development of timely creative and effective TRS Health messaging to school districts members and retirees including the planning and execution on annual health fairs for TRS retirees.
Oversees coordination on communication from TRS Health vendors to TRS Health to school districts members and retirees.
Leads staff directly and through subordinate managers including hiring directing monitoring performance management and motivating staff.
Ensures compliance with agency and department policies procedures rules regulations and laws including HIPAA COBRA and other federal and state regulations and requirements.
Assists with the preparation and presentation of ad hoc and periodic financial and department operations reports for the TRS Board of Trustees and executive management Retirees Advisory Committee Department of Insurance Legislative Budget Board school districts and other interested parties.

Business Unit Support
Oversees staff responses to inquiries from members vendors school districts and government officials to support development of training materials.
Directs the creation and delivery of training and technical assistance on program regulations policies procedures and systems.
Directs the development and execution of a quality assurance program to ensure compliance with program standards.
Drives continuous improvement initiatives to optimize operational efficiency across the department.
Analyzes and reports on training quality assurance and member engagement efforts..
Supports research and implementation of new technologies and industry practices to enhance operational effectiveness.
Manages development of process documentation and promote continuous process improvement.
Identifies strategic and operational risks and opportunities related to legislative vendor and procedural changes.
Evaluates recommend Implements enhancements to healthcare program plans policies procedures systems and forms.
Leads comparative analysis of other state group health programs to inform TRS program improvements.
Directs the coordination of procurement and contract management support by analyzing member utilization data vendor claims reports and financial metrics such as program funding and costs.
Participates in TRS-Care and TRS-ActiveCare appeals processes including review and presentation of medical documentation.

Engagement and Project Management
Oversees communications and engagement workstreams for TRS Health projects.
Monitors and manages communications-related activities of multiple external vendors to ensure quality and consistency.
Oversees the development of long-term communications strategies for marketing TRS Health programs.
Oversees stakeholder engagement to identify and implement effective communication and content strategies.
Establishes standards and procedures for TRS Health engagement processes and advise staff vendors and contractors on compliance.
Contributes to the development and revision of TRS Health publications policies and procedures.
Delivers presentations lead meetings and engage with internal and external stakeholders to advance communications objectives.
Oversees content development for TRS-Care/TRS-ActiveCare member websites and vendor platforms.
Represents TRS Health on relevant committees and task forces.
Advises on the creation of TRS Health video materials for platforms such as TRS YouTube channel.
Provides input on legislative impacts to engagement strategies and communications efforts.

Performs related work as assigned.

WHAT YOU WILL BRING:

Required Education
Bachelors degree from an accredited college or university in accounting finance mathematics statistics business health care administration or a closely related field.
High school diploma or equivalent and additional full-time experience in health care or insurance program administration pension administration benefits administration or similarly related experience may be substituted on an equivalent year-for-year basis.

Required Experience
Eight (8) years of full-time progressively responsible experience in health care regulation or insurance program administration pension administration benefits administration or similarly related experience
Four (4) years of experience leading or supervising the work of others required.
Experience leading a quality audit program.
Experience may be concurrent.
A masters degree or doctoral degree in a directly related field may be substituted on an equivalent year-for-year basis.

Required Registration Certification or Licensure
CTCM or ability to complete certification requirements within one year of hire.

Preferred Qualifications
Graduate degree from an accredited college or university.
Five (5) years of experience in operations management customer service management data analysis and/or process improvement
Five (5) years of experience in health care administration or regulation.
Experience leading a cross functional department.

Knowledge of
Health care and insurance administration.
Health benefit eligibility criteria enrollment processing Medicare and coordination of benefits.
Health Insurance Administration Plan Funding and Procurement Processes Regulatory and Compliance.
HIPAA COBRA and other relevant federal and state laws and regulations.
Customer service principles practices technology and issues.
Process and procedure Improvement methodologies.
TRS health care and insurance benefit programs.
TRS Laws Regulations Policies Procedures and information systems.
State of Texas Contract Management procedures.

Skill in
Leading multiple cross functional teams.
Interpreting and applying complex laws regulations rules and policies and making decisions based on sound judgment.
Effective program management including planning organizing and prioritizing work assignments to manage a high-volume workload in a fast-paced and changing environment meeting frequent and/or multiple deadlines and managing conflicting priorities and demands.
Managing organizing and motivating staff to meet productivity and quality goals and objectives.
Effective written and verbal communications including preparing and delivering complex reports presentations bid proposals and policies.
Negotiating issues analyzing problems and devising effective solutions.
Applying and Implementing Process and Procedure methodologies.
Using a computer in a Windows environment with word processing spreadsheet database and other business software.
Providing effective customer service.
Completing detailed work with a high degree of accuracy.
Analyzing problems and devising effective solutions.
Use of Power BI Tableau or other similar tools to create visualizations of member services operations.

Ability to
Establish and maintain harmonious working relationships with co-workers agency staff and external contacts.
Work effectively in a professional team environment.
Travel as needed to educate employers members and retirees and to monitor vendors and contractors.