Operational Excellence Analyst III (Hybrid location preferred)

Job Summary:

Operational Excellence Analyst III is responsible to take a leading role in the oversight and monitoring of Operations regulatory requirements, and Service Organization Control-1 (SOC-1) controls. Hybrid location- 2 days in Dayton, OH office and 3 days remote- is preferred.

Essential Functions:

• Take a leading role in the oversight and monitoring of Operations specific HEDIS initiatives and accreditation requirements
• Interpret regulatory requirements to identify gaps and drive improvements
• Demonstrate leadership ability, including mentoring Operational Excellence Analysts  to identify and perform oversight and monitoring of Claims, Provider Appeals, Provider Services (claims processing only), Provider Life Cycle and Enrollment processes
• Generate comprehensive, clear, concise, and in-depth reporting and analysis and provide recommendations based on findings
• Conduct monthly quality reviews with the Operations Management team
• Work under limited supervision with considerable latitude for initiative and independent judgement
• Performs a variety of reviews or evaluations that are usually without precedent and requires the use of advanced techniques in gathering and evaluating pertinent data
• Work cross-functionally with the Operations Management team to identify risks, controls, and 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, or equivalent years of relevant work experience is required
• Minimum of five (5) years of health care operations experience in insurance, managed care, or related industry is required

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
• 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, written, and interpersonal communication skills
• Ability to manage time effectively
• Effective relationship management skills
• Effective organization and prioritization skills
• Effective facilitation and interpersonal skills
• Strong critical thinking and problem resolution 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:

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 (hourly/salary):

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business