Company Details

Operations Specialist

Job ID

: 22552


: Mason, OH 45040, USA


: Not Specified

Job Views

: 120


: 09-05-2019

Key Skills

operations excel

Job Description

Key Responsibilities:

- Maintain proper internal controls and risk management with respect to membership processing & reconciliation, billing, and claims processing.
o Maintain the integrity of membership data in the  eligibility system.
o Has an analytical responsibility for resolution of member eligibility, claim and billing discrepancies.
o Responsible for ensuring constituent satisfaction, with creative thinking and quick response & resolution.
o Maintain a working knowledge of systems that include the claims and eligibility system, and constituent facing systems (Exclaim, , member web, Call Center interface).
- Effectively manage client initiatives including:
o Overall management and execution of specific client operational projects: define scope, create project timeline with defined key deliverables, negotiate and complete business requirements, drive resolution of non-standard requests, and communicate status of outstanding issues to Client leadership teams.
o Provide complete and timely communication and reporting to manager related to client projects in process.
o Comply with standards of administration as defined by functional areas. Responsible for meeting deadlines as defined by clients and various functional areas.
- Drive client satisfaction:
o Lead the post-implementation operational support of operations issue resolution.
o Analyze, report and drive for resolution of membership, billing, and claims processing trends with the goal of improving effectiveness.
o Participate in client meetings to ensure understanding of client needs and provide operational guidance.
o Develop and maintain relationships with clients on multiple levels and across business lines
- Drive Key Performance Indicators:
o Ensure client operational changes are implemented for cross functional and client satisfaction.
o Ensure backup plans are developed and implemented to effectively respond to unplanned situations within standards.

Minimum (Required) Qualifications:
- Bachelor’s Degree or equivalent experience
- 3 years client-facing experience
- 2 years’ experience in an operational liaison role
- Strong B2B customer service focus
- Strong written and verbal communication skills
- Ability to troubleshoot, analyze and problem solve on projects and data issues
- Ability to work well independently, under pressure and multi-task
- Knowledge of Microsoft, including advanced MS Excel and MS Access
- Knowledge of query reporting and large scale data analysis

Job Category
Employment Types
Contract - W2
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