Operations Support Analyst II-2

Operations Support Analyst II-2

Requirements

• High School Diploma/GED required.
• 5 years experience in health insurance operations preferably in a related role.

Responsibilities

• Provide guidance and support to more junior staff: conducting formal observations to assess junior coach performance and/or progress.
• Assist internal team members and outsourced staff in reviewing errors, responding to audit inquiries, and handle more complex work assignments.
• Participate in on-boarding, competency identification, execution of development plans, talent management, etc.
• Identify trends, recommend changes to processes including workflows, assess process deficiencies, and conduct one on one mentoring.
• Escalate system and operations issues reported to business owners or identified through analysis and assist with problem resolution.
• Produce daily educational bulletins to enhance quality.
• Collaborate with Training Quality and Operations during and after training period to ensure optimal learning experience, smooth post-training transition, on-going monitoring and training alternatives. Responsible for cross-training new/existing training at Horizon sites and at remote vendor locations.
• May represent Operations unit at cross-functional meetings and work group sessions.
• Assist Supervisor with the modification of training resources/schedules in response to staffing issues and/or business needs.
• Monitor provisions and make recommendations to Service Level Agreements (SLAs) to ensure productivity and quality goals are met.
• Work with business units in conducting gap analysis and/or review data/metrics to determine if training solution is needed and if so, what type is required.
• Participate in cross-functional meetings and work group sessions to identify improvement opportunities.
• Partner with stakeholders to develop and deliver learning solutions in support of new products, new/upgraded systems and business initiatives.
• Responsible for training and delivery at Horizon sites and at remote vendor locations.
• Collaborate with other Service Training & Development areas (Instructional Design & Knowledge Management) to provide input into learning solution program design and implementation.
• Serve as testers of workflows and processes of business/systems supported.
• Assist with inventory management.
• May also be responsible for other T& D elements such as Instructional Design if performing this function in a specialized business unit.
• Perform other relevant tasks as assigned by management.

Preferred Qualifications

• Knowledge of Complaints and Appeals process preferred.
• Knowledge of Ncompass, NASCO, CareRadius and Facets Application preferred.
• Requires knowledge of current industry trends and Best Practices.
• Requires healthcare industry knowledge.
• Requires claims processing experience.
• Strong PC skills.
• Organizational, Multitasking, Analytical Thinking and strong Interpersonal and Presentation Skills.