Operational Excellence Analyst II/Hybrid

Job Summary:

The Operational Excellence Analyst II is responsible for the oversight and monitoring of Operations regulatory requirements and Service Organization Control-1 (SOC-1) controls.

Essential Functions:

• Oversight and monitoring of Operations specific HEDIS initiatives and accreditation requirements
• Identify and perform oversight and monitoring of Claims, Provider Appeals, Provider Services (claims processing only), Provider Life Cycle and Enrollment processes
• Generate monthly reporting and recommendations based on findings
• Conduct monthly quality reviews with the Operations Management team
• Work cross-functionally with the Operations Management team to identify 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 degree in Management Information Systems (MIS), business analysis, or equivalent work experience is required
• Two to five (2-5) years of experience translating business requirements into technical specifications is preferred

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 is preferred
• 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 and written communication skills
• Ability to manage time effectively
• Effective relationship management skills
• Effective organization and prioritization skills
• Effective facilitation and interpersonal 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:
$61,500.00 - $98,400.00 CareSource 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:
Salary

Competencies:
- Create an Inclusive Environment
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.