Job Summary:
Operational Excellence Analyst III is responsible to take a leading role in the oversight and monitoring of Operations regulatory requirements, and Service Organization Control-1 (SOC-1) controls. Hybrid location- 2 days in Dayton, OH office and 3 days remote- is preferred.
Essential Functions:
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Take a leading role in the oversight and monitoring of Operations specific HEDIS initiatives and accreditation requirements
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Interpret regulatory requirements to identify gaps and drive improvements
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Demonstrate leadership ability, including mentoring Operational Excellence Analysts to identify and perform oversight and monitoring of Claims, Provider Appeals, Provider Services (claims processing only), Provider Life Cycle and Enrollment processes
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Generate comprehensive, clear, concise, and in-depth reporting and analysis and provide recommendations based on findings
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Conduct monthly quality reviews with the Operations Management team
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Work under limited supervision with considerable latitude for initiative and independent judgement
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Performs a variety of reviews or evaluations that are usually without precedent and requires the use of advanced techniques in gathering and evaluating pertinent data
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Work cross-functionally with the Operations Management team to identify risks, controls, and process gaps and drive improvements Identify and lead process-improvement initiatives
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Track financial savings related to process improvements
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Track financial cost related to outages and process issues
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Perform any other job duties as requested
Education and Experience:
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Bachelor of Science/Arts, or equivalent years of relevant work experience is required
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Minimum of five (5) years of health care operations experience in insurance, managed care, or related industry is required
Competencies, Knowledge and Skills:
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Intermediate proficiency level with Microsoft Office suite, including Microsoft Project, Visio and Minitab is preferred
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Advanced troubleshooting and problem-solving capabilities
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Data analysis and process mapping preferred
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Overall knowledge and understanding of Operations-related systems, technical specifications and processes is preferred
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Solid understanding of claims processing
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Ability to conduct oversight, monitoring, and auditing of operational areas
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Ability to understand and translate SOC-1, accreditation and regulatory requirements
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Ability to document and maintain business and system requirements including process flows
- Ability to analyze processes and produce recommendations for improvements
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Excellent oral, written, and interpersonal communication skills
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Ability to manage time effectively
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Effective relationship management skills
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Effective organization and prioritization skills
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Effective facilitation and interpersonal skills
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Strong critical thinking and problem resolution skills
Licensure and Certification:
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Six Sigma Green or Black Belt is preferred
Working Conditions:
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General office environment; may be required to sit or stand for extended periods of time
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May be required to travel, estimated at less than 10%
Compensation Range:
$72,200.00 - $115,500.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
#LI-SD1
Brand=CareSource
