10 Career Opportunities in Health Insurance

Two weeks ago, I wrote here on my blog about some implications of the potential merger of two local health insurance companies, Harvard Pilgrim and Tufts Health Plan.  In response to that post, I received some questions about layoffs due to a merger.  In an increasingly complex industry, the company faces the challenge to remain an attractive product while also doing "the right thing" for members and employees.  So can there be layoffs?  Sure.  Will there also be new career opportunities?  Sure.  I see the need to move employees into new roles to help the company succeed.  As we face a new horizon for what a new valuable Health Plan really can be, new roles must be considered to propel the Health Plan and make it efficient, competitive and grow.  So here is my forecast of ten upcoming career opportunities within any health plan that wants to be efficient, competitive and grow.

1)Re-engineering Process and Systems

As health consumers demand lower costs in healthcare, everyone must do a part to decrease the administrative cost wherever we can.  Now is the time to take a look at current processes and brainstorm how they can be made more efficient.  The optimized process will also identify new system solutions that will enable the new efficiencies.  If the re-engineering is done well, I believe it will be the key driver in lowering cost and create a dominant market appeal.  Employees with knowledge of current business process, current systems and who are forward thinking will be needed to achieve these efficiencies by defining the new processes and implementing the new systems.

2)Vendor Management

With the re-engineering effort, many new service vendors will be in consideration.  Employees will be needed to take a look at existing contracts, re-negotiate contracts and draft new contracts with existing/new vendors.

3)Growth Strategy

How aggressive does the company want to be in signing on new employer groups and members?  What is the best way to compete with competitors?  What will be the strategy?  Employees will be needed to help the company achieve membership goals through building the winning growth strategy.  In the case of Harvard Pilgrim and Tufts Health Plan, they together will be offering insurance in: Massachusetts, Maine, New Hampshire, Rhode Island and must strategize on membership growth starting in these four states.

4)Actuarial

Actuarial is a good role to get into within the industry because there always seems to be a shortage in Actuarial professionals that understand the risk factors in health insurance.  Due to many federal and state regulations now and in the future, Actuaries are needed to analyze the increasing number of new business scenarios, such as New Product Designs (for example, upcoming MA Division of Insurance select/tiered provider network product designs) and new provider reimbursement methods.

5)Healthcare Informatics
Healthcare Informatics is hot now and will continue to be for some time.  Employees will be needed to slice and dice the data to find ways to lower cost, measure results of new programs, monitor provider quality and segment members to offer personalized care.

6)Regulatory Projects

Now until 2016, there will be a focus on Regulatory Projects, such as ICD-10, Federal Health Reform and additional Federal and State Mandates.  Employees that understand the health insurance business and systems will be needed to make policy, process and system changes.

7)Social Media Management

Social Media Management is about protecting and extending the company brand.  Social Media Managers monitor what is being said about the company online, such as reviewing web posts, Twitter comments and Facebook comments.  If faced with a poor review/comment, the Social Media Manager performs damage control by offering to help and hear the situation (sometimes taking the follow-on conversations offline due to privacy).  The Social Media Manager will also perform some marketing and public relations activities to promote the company brand.  Social Media Management is a fairly new career opportunity in the health insurance industry.  Don’t forget that Social Media should be managed in the Member and Provider online mediums.

8)Multi-Lingual Services

In an increasingly diverse country, it is important to provide Multi-Lingual services via written and spoken mediums.  There is a push from consumer advocate groups to better engage, educate and support non-English speaking consumers to promote public health and better access to care.  Healthcare organizations have created units in order to better service the non-English speaking population.  Employees with capability to speak/write a foreign language, perform English translations and who possess good customer service skills are needed to fill these roles.

9)Leadership Development Program

With a growing number of health plan employees approaching and taking retirement, health plans must make investments to ensure that the health plan is able to carry forward a strong business into the future.  A Leadership Development Program can be a rotational, mentorship program to train promising staff to become the next leaders.  Participants in the Leadership Development Program must be offered incentives to stay with the company after the Program is over, otherwise, they may take their talent to other companies.  The desired skill set for candidate selection into a Leadership Development Program, should be: vision, social responsibility and integrity.

10)New Business Ventures

As the health plan recognizes that their core competency is offering insurance, they may begin to diversify into different States and other insurance products, like comprehensive dental insurance, stop loss insurance or worker's compensation.  Any of these would be a huge effort and would require experienced human resources with different skill sets in order to make this possible.