Issue Resolution Coordinator - Consultant III

This position requires the candidate to reside in the KP Washington region

Issue Resolution Coordinator (Consultant III will be an experienced business and claims operations professional with expertise in Premier Systems
, claims issue resolution
, Office of Insurance Commissioner (OIC) complaint management
, Business Objects reporting
, and requirements development
. Serves as a liaison between business and technical teams to gather, analyze, and document business requirements, ensuring effective system enhancements and operational improvements. Skilled in coordinating the development of Premier macros, batch rules, and claim processing solutions while supporting testing and validation activities prior to implementation.

Acts as a Subject Matter Expert (SME) for claims adjudication and processing issues, driving investigation, resolution, and workaround management for complex claims. Develops and distributes ad hoc reports and stakeholder communications, facilitates cross-functional issue resolution work groups, and coordinates end-to-end resolution of OIC complaints and other operational initiatives. Demonstrated ability to improve processes, support compliance requirements, and deliver timely solutions in a fast-paced healthcare claims environment.

Serves as part of a consulting team to ensure the alignment, buy-in, and coordination of diverse stakeholders to drive the implementation of successful business initiatives and projects. Provides insight and supports the development and implementation of business initiatives, systems, and/or processes to a desired future state. Supports strategic planning and organizational alignment and prioritization of business initiatives. Manages moderately complex projects or project components, participates in change management activities, and performs data analyses in support of business initiatives.

Supports vendor management as required. Monitors compliance of work activities by ensuring business plans and team members adhere to relevant policies and procedures.

• Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members. Listens to, seeks, and addresses performance feedback; provides mentoring to team members. Pursues self-development; creates plans and takes action to capitalize on strengths and develop weaknesses; influences others through technical explanations and examples. Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work;
  
  helps others adapt to new tasks and processes. Supports and responds to the needs of others to support a business outcome.

• Completes work assignments autonomously by applying up-to-date expertise in subject area to generate creative solutions; ensures all procedures and policies are followed; leverages an understanding of data and resources to support projects or initiatives. Collaborates cross-functionally to solve business problems; escalates issues or risks as appropriate; communicates progress and information. Supports, identifies, and monitors priorities, deadlines, and expectations. Identifies, speaks up, and implements ways to address improvement opportunities for team.

• Serves as part of a consultant team to ensure the alignment, buy-in, and coordination of diverse stakeholders to drive the implementation of successful business initiatives and projects within a functional track or workstream by identifying and ensuring representation and inclusion of appropriate stakeholders; building rapport and partnerships with stakeholder teams, third party vendors, and senior management; working with stakeholders to develop goals and set the prioritization of deliverables;
  
  identifying and escalating tough stakeholder issues while maintaining an independent perspective; preparing presentations and reports; and leading or facilitating team meetings.

• Develops requirements for business, process, or system solutions within assigned business domain(s) by interfacing stakeholders and cross-functional teams as appropriate; leveraging multiple business requirements gathering methodologies to identify business, functional, and non-functional requirements; and developing and documenting comprehensive business cases to assess the costs, benefits, and ROI of proposed solutions.

• Provides insight and supports the development and implementation of business initiatives, systems, and/or processes to a desired future state by maintaining a working understanding of how current processes impact business operations; mapping current state against future state processes; identifying the operational impact of requirements on upstream and downstream solution components; providing options and recommendations to management and business stakeholders on how to integrate solutions and deliverables with current systems and business processes;
  
  and identifying and validating value gaps and opportunities for process…