Job Summary:
- Assists in activities for the business function (or multiple functions) within assigned area of operations, internal and/or external
- Root Cause Analysis, Trending, and Process Improvement
- Assignments are broad in nature
Key Duties and Responsibilities:
- Accountable for critical/complex processes or functions within the department
- Provides guidance on assigning workload, monitoring quality and associate coaching; coordinates work of others
- Serves as liaison between departments when it becomes necessary due to member or workflow issues
- Develops, recommends, and implements process improvements to improve efficiencies and services provided
- Manages key project initiatives including, setting deadlines, assigning responsibilities, and monitoring/summarizing project progress
- Completes root cause analysis on error reports from operations and from business units
- Completes trending analysis on reports utilizing problem solving skills
- Updates and creates resources on link applicable to assigned area, such as timely announcements, step actions, reference call tools, FAQs etc.
- Ensures associates are trained on new processes and receive refresher training
- Creates/revises training as needed
- Facilitates and participates in meetings with other departments and line of business as needed
- Act in a liaison capacity for the Mgr/Sr Mgr representing Operations with other areas and business units
- Completes gap analysis on training for the business
- Other duties as assigned
Education:
- A High School or GED or equivalent required
- Or equivalent work experience required
- A Bachelor’s Degree in a related field preferred
Work Experience:
- 4+ years of experience in a related field required
- Other Previous experience in a customer service environment and health insurance preferred
Skills:
- Demonstrated analytical skills
- Demonstrated written communication skills
- Demonstrated interpersonal/verbal communication skills
- Ability to communicate and make recommendations to upper management
- Other Strong understanding of managed care and its place in the health care industry
- Other Understanding of interdependencies on other business units such as Health Services, Provider Relations, Sales, Vendors, Claims