Responsible for performing high-level reporting, engaging in predictive trend analysis and making subsequent business process improvement recommendations for customer service and provider operations.
Department: 5102 - Ops - Quality
Manager title: Mgr. Operations
Additional Responsibilities:Candidate Education:
- Research, understand, problem solve and report root cause of metric variances and propose possible business solutions.
- Serve as subject matter expert regarding all process flows including understanding systems used and functions performed within each work type, dependencies/interactions and identification of potential impact resulting from changes
- Assist in maintaining all project-related matters (e.g. action plans, tracking tools) and reporting to senior leadership as appropriate.
- Responsible for leading cross-functional departmental planning sessions, and ensuring appropriate action planning results are executed.
- Represent department in various task forces/committees, and presenting to executive and other senior leadership.
- Coordinate project activity and facilitate project meetings with staff and inter-departmental partners.
- Develop and maintain interdepartmental relationships to ensure proper involvement, cooperation and communication of changes are executed appropriately.
- Builds and maintains positive business relationships with business partners at all levels of the organization, including executives.
- Ability to support concurrent projects in an organized manner and meet agreed upon SLAs.
- Participates in the formulation of project time estimates, and leverages cross-functional relationships.
- Ensures adherence to quality processes and procedures.
- Assist in the development and maintenance of various policies and procedures affecting the operations of the department.
- Develops ad-hoc reports to conduct data analysis and validation.
- Perform on-demand, rapid data analytics and reporting of multiple inputs/sources.
- Develop and maintain comprehensive reports providing management with visibility to processor/team productivity and other departmental metrics.
- Develop, document and implement process improvement opportunities.
- Analyze trends, identity opportunities and recommend process and/or operational improvements.
- Researches methodologies and conducts advanced metric reporting.
- Provide ongoing operational analysis of process components, while identifying and implementing changes as necessary to improve the level of quality and efficiency as measured by key performance indicators.
- Responsible for capturing and documenting metrics in support of the user acceptance testing and recommends improvements.
- Assist in system requirements gathering and testing to ensure accuracy across systems.
- May also assist in preparing various management related reports.
- Perform all other related duties as assigned.
- Required A High School or GED
- Preferred A Bachelor's Degree in a related field
- Required 3 years of experience in reporting, metrics analysis, quality and/or related function
- Required 2 years of experience in working on interdepartmental projects
- Preferred Other Health care analytics
- Preferred Other Wellcare system knowledge
Licenses and Certifications:
- Intermediate Demonstrated analytical skills Ability to perform detailed review, research, and analysis to ensure accuracy of enrollment process in to Peradigm system
- Intermediate Ability to analyze information and covert related activities into a comprehensive work plan
- Intermediate Other Demonstrated technical expertise in performing quality reviews with analysis of results
A license in one of the following is required:
- Required Advanced Other MS Office, including Excel, Powerpoint and Word