Chief Operating Officer

Executive Management Irvine, California


Description

Western Growers Assurance Trust (WGAT) was founded in 1957 to provide a solution to a need in the agricultural community — a need for employer-sponsored health benefit plans not previously available from commercial health insurance carriers. WGAT is now the largest provider of health benefits for the agriculture industry. The sponsoring organization of WGAT is Western Growers Association, created in 1926 to support the business interests of employers in the agriculture industry. WGAT’s headquarters is located in Irvine, California.

WGAT’s mission is to deliver value to agriculture-based employer groups by offering robust health plans that meet the needs of a diverse workforce. By working at WGAT, you will join a dedicated team of employees who truly care about offering quality health benefits and excellent customer service to plan participants. If you want to start making a difference working in the health care industry, then apply to WGAT today!

Job Description Summary

Reporting to the President/CEO of Western Growers Association (“WGA”), the Chief Operating Officer (“COO”) will have P&L accountability for Western Growers Assurance Trust (WGAT) and Pinnacle (PCMI) and its affiliated entities, except Covered California Small Business contracts and supporting division, TPA customer service/call center, sales and retention. The COO will identify, develop and execute strategic initiatives designed to support the delivery of competitive health benefit products and services to the agricultural industry (WGAT) and both ag- and non-ag clients (PCMI).  This position will ensure the alignment and execution of deliverables from key leaders and cross-functional workgroups in a matrixed organization.  

 

The COO serves as the key leader in the WGA Senior Management Team that links strategic planning objectives with day-to-day operational execution. They are responsible for making timely, informed decisions that consider the facts, goals, constraints, and risks.  This position has three (3) direct reports; the Vice President of Health Management and Clinical Services, the Vice President Operations, the Chief Information Officer.

Qualifications

  • Minimum of a BA/BS and 15 years of executive responsibilities overseeing the operations of a health insurance carrier. A graduate degree is preferred but not required.
  • Demonstrated experience in health benefits finance and operations including, but not limited to: provider contracts, COBRA administration, plan designs, disease management, ERISA compliance, pharmacy benefits, other ancillary products, claims adjudication, fully funded and self-funded models. Experience in underwriting is not required but preferred.
  • Excellent understanding of all Federal and State laws and regulations relating directly to the Affordable Care Act (ACA), ERISA, HIPAA, and all compliance relating to California’s Department of Insurance and the Department of Labor (DOL).
  • Proven success at owning a P&L with a record of profitable market share growth, developing a vision, and implementing the strategies and tactics to successfully execute in a matrixed environment.
  • Exceptional oral and written communication abilities, especially those in the “C” suite, Board of Trustees, and Board of Directors.
  • Good understanding of the Microsoft Office Suite, spreadsheets, presentations, etc.
  • Advanced experience in executing strategic and tactical communications that resulted in program growth, client retention, and trust-building with stakeholders.
  • Requires strong financial analysis and modeling skills to oversee financial analyses to assist in the exploration of strategic options, the development of creative solutions to complex issues, and decision-making support.
  • Solid understanding of best branding, marketing, and sales practices.
  • Proven ability to lead efforts to grow business lines.
  • Verifiable, clean DMV record and the ability to travel to various locations throughout the U.S. (mainly California and Arizona) up to 10% of the time.

Duties And Responsibilities

WGAT/PCMI Operational Oversight (Long-term Planning)

  • Articulate strategies and plans that focus on sustainable, profitable growth, healthcare value and quality, operational efficiency, and financial performance for WGAT and PCMI.
  • Ensure technical areas align with the organization’s strategic direction and comply with the current federal landscape and overall industry direction
  • Drive execution of health benefit strategies and programs supporting achievement of financial goals.
  • Obtain commitment from internal and external stakeholders for the delivery of business objectives.
  • Utilize stakeholder input to shape and implement continuous improvement in operational, clinical, and financial performance.
  • Drive delivery of exceptional levels of customer service and satisfaction.
  • Ensure a coordinated approach to provide a seamless face to WGAT and PCMI customers. The COO will have ultimate responsibility for:
    • Operations Management: Claims Processing, Customer Service/Call Center Operations, Database Maintenance, Eligibility and Enrollment, Finance, Group Set Up, Health Benefit Plan Coding/Testing, Installation Reinsurance and Recoveries, and Training.
    • Network Management: Leased Network Partners, Proprietary Contracted Network
    • Medical Management: Disease Management, Prior Authorization, Case Management, Population Health, and Wellness.
    • Technology Management: Software Development and Technological Infrastructure Maintenance (Networks and Computer Systems), System Security Management, and Disaster Recovery.

WGAT/PCMI Operational Oversight (Near-term Tactics)

  • Analyze and evaluate the performance of Western Growers Assurance Trust and Pinnacle Claims Management, including operational/ systems, policies, current leadership, management processes, overall efficiencies, and effectiveness. All objectives and decisions are directed toward improving how these entities conduct business and bring exceptional service to members, customers, and clients.
  • Prepare, direct, and coordinate the financial and budget activities to fund operations, maximize financial investments, particularly in areas where a financial commitment is established.
  • Identify opportunities for the organization to leverage cross-functional strengths and improve/streamline operational functions.
  • Examine the current Health Care Processing System (HCPS) to determine future viability, determine its inefficiencies and ineffectiveness and develop improvement plans.
  • Work with the EVP, WGAT/President, PCMI to ensure all business lines, programs, and health plan management activities are strategically and operationally aligned.

Management & Leadership

  • Model exceptional leadership and corporate cultural practices.
  • Create a culture of mutual respect, accountability, and partnership between functional areas and the AT/PCMI divisions in alignment with the vision of the President/CEO.
  • Develop, manage, and lead a team of 3A+ self-accountable professionals.
  • Develop a culture of authentic, personal accountability by modeling the behavior that defines it.
  • Instill a culture of safety and expectation within your respective area/s.
  • Require direct reports to hold themselves accountable to high performance and personal conduct standards in a clear, helpful, straightforward way.
  • Conduct one-on-one conversations with every direct report quarterly focused on their 3A+ capabilities, impact, and effort.
  • Make decisions and choices, impacting staff, by using the steps outlined in the “Outward Mindset Skills for Leaders” guide.

Other

  • Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively. Be willing to adjust efforts to ensure that work and attitude are helpful to others, being self-accountable, creating a positive impact, and being diligent in delivering results.
  • Maintain a clean DMV record and the ability to travel to locations throughout the U.S. (mainly California and Arizona) up to 10% of the time.
  • All other duties as assigned.

Physical Demands/Work Environment

The physical demands and work environment described here represent those that an employee must meet to perform this job’s essential functions successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to communicate with others. The employee frequently is required to travel to both indoor and outdoor areas that can vary in exposure and temperature. The employee is frequently required to operate a motor vehicle, use objects, tools, or controls, and/or required to lift up to 50lbs. The noise level in the work environment is usually moderate.