Operational Excellence Analyst III (Hybrid location preferred

Position: Operational Excellence Analyst III (Hybrid location preferred)
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:

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 - $Care Source 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. Care Source reserves the right to amend this job description at any time. Care Source is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.#LI-SD1

Brand=Care Source
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