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 schedule: In Dayton office on Wed/Thurs. Work remote the other days.
Essential Functions:- Take a leading role in the oversight and monitoring of Operations specific HEDIS initiatives and accreditation requirements
- Interpret regulatory requirements to identify gaps and drive improvements
- 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
- Generate comprehensive, clear, concise, and in-depth reporting and analysis and provide recommendations based on findings
- Conduct monthly quality reviews with the Operations Management team
- Work under limited supervision with considerable latitude for initiative and independent judgement
- 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
- Work cross-functionally with the Operations Management team to identify risks, controls, and process gaps and drive improvements Identify and lead process-improvement initiatives
- Track financial savings related to process improvements
- Track financial cost related to outages and process issues
- Perform any other job duties as requested
Education and Experience:- Bachelor of Science/Arts, or equivalent years of relevant work experience is required
- Minimum of five (5) years of health care operations experience in insurance, managed care, or related industry is required
Competencies, Knowledge and Skills:- Intermediate proficiency level with Microsoft Office suite, including Microsoft Project, Visio and Minitab is preferred
- Advanced troubleshooting and problem-solving capabilities
- Data analysis and process mapping preferred
- Overall knowledge and understanding of Operations-related systems, technical specifications and processes is preferred
- Solid understanding of claims processing
- Ability to conduct oversight, monitoring, and auditing of operational areas
- Ability to understand and translate SOC-1, accreditation and regulatory requirements
- Ability to document and maintain business and system requirements including process flows
- Ability to analyze processes and produce recommendations for improvements
- Excellent oral, written, and interpersonal communication skills
- Ability to manage time effectively
- Effective relationship management skills
- Effective organization and prioritization skills
- Effective facilitation and interpersonal skills
- Strong critical thinking and problem resolution skills
Licensure and Certification:- Six Sigma Green or Black Belt is preferred
Working Conditions:- General office environment; may be required to sit or stand for extended periods of time
- 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 - Fostering a Collaborative Workplace Culture
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time.#LI-SD1
