Your Future is our Future

At Lumeris, we believe that our greatest achievements are made possible by the talent and commitment of our team members. That's why we are actively seeking talented and collaborative individuals who are passionate about making a difference in the healthcare industry. Join us today as we strive to create a system of care that every doctor wants for their own family and become part of a community that values its people and empowers you to make an impact.

Position:

Sr. Director, Operational BI and Data Integrity

Position Summary:

As the Sr. Director of Operational Business Intelligence and Data Integrity, you will be a change agent who builds trust in the fidelity of data used to empower timely, data driven strategic and tactical decisions for our Medicare Advantage health plan. Understanding that data is a powerful asset, you will build foundational data integrity in support of accurate and actionable reporting and analytics. As a leader with deep and broad health plan expertise, both operational and technical, this role works across multiple functional areas to drive data governance and integrity, implementing and overseeing data management and migration structure and process to support the business, driving leading edge core competencies in internal and customer driven business insights.

This role holds expertise in both business and technical functions, optimizing skill sets and efficiencies through clarification of business needs, and translating them into technically sound business requirements. Success is measured through the translation of disparate static reports into actionable insights and meaningful self-service capabilities. This role ensures that all regulatory and operational reporting is sound and accurate, with change control and data governance.

This role serves as the link between business strategy and reporting and analytics teams, incorporating all new business strategies, regulatory guidelines, and technical documentation into a well-established and rapidly growing organization. With deep understanding of the nuances of provider, member and claims data and their financial implications, this individual prevents rework and increases the reliability of our data.

Job Description:

Primary Responsibilities

• Lead Operational Business Intelligence and Data Integrity strategy, ensuring alignment with organizational goals and regulatory requirements.

• Drive strategic data governance, policies, and practices in coordination with shared services Data Governance, AI Governance, and Analytics teams.

• Lead the Organizational and Operational Business Data Intelligence Strategy.

• Leverage Sophisticated Business Case methodology to demonstrate clear ROI for proposed and implemented solutions.

• As a link between the Executive Leaders, Business Operations, Compliance, and Information Systems, meet operational efficiency, CMS reporting, and financial forecasting needs by eliciting detailed and strategic business requirements, leveraging health plan data and business expertise, to ensure reporting teams are equipped with clear technical business requirements.

• Through process improvement methodologies, identify opportunities and recommend solutions to simplify and automate process and plan product delivery, including but not limited to AI solutioning.

• Aligning with Lumeris shared services Data Governance practices, AI Governance, and Data and Analytics teams across the organization.

• In conjunction with Operations, Product, Sales, Network, Finance and IS, develop approved business rules and algorithms that ensure operating systems are designed/built/configured to allow for modularity, reporting, consistency, and clarity.

• In collaboration with IS, develop policies and documented reporting requirements to maintain a high level of data fidelity as data moves throughout enterprise, ensuring business processes and reporting practices leverage and support this fidelity. Drive accountability for business data content ownership in QA processes.

• Partner with Database Administrators (DBAs) to maintain a high performing system that supports the business from a regulatory and operational standpoint.

• Foster an environment of innovation and execution utilizing data management best practices.

• Create, communicate, and implement policies and procedures to drive the department’s vision, mission and operational data and analytics direction.

• Proactively identify technical capability deficits in the business operations team and provide training and testing for consistency.

• Coach, mentor, and develop subordinate leaders and staff to build organizational capacity, deliver results through others, and sustain long-term strategic success.

Qualifications

• Typically requires 15+ years of relevant experience with 7+ years of progressive leadership experience, including demonstrated success influencing at the director level or above.

• Degree in Computer Engineering or the equivalent, plus a minimum of 10 years in strategic business data management and development.

• Certification/licensure in data management, analytics, or health plan operations a plus.

• 10+ years leading a Business Analytics Strategy, Operational Business Intelligence Strategy or Data Management division with 5+ years in Health Plan Sector.

• Demonstrated understanding of Regulatory Requirements and Provider/Population Health Hierarchies and the role of data and reporting

• Proven success working across multiple functional areas within an organization to successfully incorporate new business strategy, regulatory guidelines and technical documentation to grow and scale a well-established and rapidly growing organization.

• Experience Interpreting and Designing part C and D Reporting with successful audit results.

• Proven experience delivering measurable ROI through automation, BI analytics, and operational efficiency initiatives.

• Able to lead through Influence. Manages multiple tasks, be detail oriented, responsible and show an elevated level of critical thinking.

• Strong executive presence, with excellent communication, negotiation, and influencing skills across all levels of the organization.

• Proven ability to deliver results through others while balancing strategic innovation and operational execution.

• Ability to work well in a fast-paced environment that is undergoing change.

• Telework available; Some travel required.

Working Conditions

• While performing the duties of this job, the employee works in normal office working conditions.

#LI-Remote

Pay Transparency:

Factors that may be used to determine your actual pay rate include your specific skills, experience, qualifications, location, and comparison to other employees already in this role. In addition to the base salary, certain roles may qualify for a performance-based incentive and/or equity, with eligibility depending on the position. These rewards are based on a combination of company performance and individual achievements.

The hiring range for this position is:

$175,300.00-$249,100.00

Benefits of working at Lumeris

• Medical, Vision and Dental Plans

• Tax-Advantage Savings Accounts (FSA & HSA)

• Life Insurance and Disability Insurance

• Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days)

• Employee Assistance Program

• 401k with company match

• Employee Resource Groups

• Employee Discount Program

• Learning and Development Opportunities

• And much more...

Be part of a team that is changing healthcare!

Member Facing Position:

No- Not Member or Patient Facing Position

Location:

Remote, USA

Time Type:

Full time

Lumeris and its partners are committed to protecting our high-risk members & prospects when conducting business in-person. All personnel who interact with at-risk members or prospects are required to have completed, at a minimum, the initial series of an approved COVID-19 vaccine. If this role has been identified as member-facing, proof of vaccination will be required as a condition of employment.

Disclaimer:

• The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individual with disabilities to perform the essential job duties and responsibilities.

Lumeris is an EEO/AA employer M/F/V/D.