Operational Excellence Analyst III (Prefer Hybrid)

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. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

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