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Serves as a department SME for a wide range of tasks and special functions to include vendor support, training, quality reviews, new business implementations, reporting analytics, process improvement, etc.
Serves as liaison between department and business partners, both internal and external.
Plan, manage, monitor, perform UAT and complete key improvement projects in an accurate and timely manner.
Identifies, evaluates, recommends and implements data-driven process improvement initiatives.
Provide support on tasks and special functions such as vendor oversight, contracting, inventory monitoring, reporting, new business implementations, quality reviews, root cause analysis, training, operational processes, etc.
Maintains/ Creates resources applicable to assigned area, such as timely updates to training, announcements, step actions, reference call tools, FAQs etc.
Represents team in cross functional environment and collaborates with leadership to implement new processes.
Partners with WellCare vendors supporting operations. Supports and assists all LOB’s with specific focus on Health Services, Pharmacy, Medicaid, Exchanges, Medicare and PDP, etc.
Investigates problems of a moderately complex nature and provide findings, impact, remediation and preventative actions in a clear and concise manner.
Analyzes data and reports to identify trends, operational issues, financial impact of implemented initiatives, etc. May need to run existing SQL queries to generate data into Excel to conduct research and analysis.
Other duties as assigned.
Required A High School or GED
Preferred A Bachelor's Degree in a related field
Required 3 years of experience in a related field based on assigned area
Preferred Other Previous experience in a customer service environment and health insurance
Intermediate Demonstrated analytical skills
Intermediate Demonstrated written communication skills
Intermediate Demonstrated interpersonal/verbal communication skills
Beginner Ability to communicate and make recommendations to upper management
Intermediate Other Strong understanding of managed care and its place in the health care industry
Intermediate Other Understanding of interdependencies on other business units such as Health Services, Provider Relations, Sales, Vendors, Claims
Beginner Other Demonstrate ability to implement process improvements
Licenses and Certifications: A license in one of the following is required: