Under general supervision, of the Manager of Operations the primary responsibility for Operations Specialist position is to assist with ensuring the Plan’s organizational productivity and efficiency. This position works closely with other Plan staff, and community partners to promote member and stakeholder satisfaction. In addition, the Operations Specialist will assist with identifying and communicating with staff as needed to improve processes in order to ex the Plan’s performance. The Operations Specialist will support successfully implementing new strategic goals and activities.
Essential Duties (at least 5 that are non-negotiable duties and are absolutely pertinent to successfully completing the job without accommodations):
An Essential job function meets the following tests:
• Working your assigned shift(s) (days and/or weekends)
• Assists the Operations Team with creating and distributing member materials including fulfillment and the website
• Provides technical guidance to the Plan staff including handling general inquiries, concerns, and vendor access requests.
• Assists with developing and implementing policies and procedures to ensure activities are consistently applied across the Plan.
• Assists with the Plan’s performance standards as they relate to vendor reports to ensure compliance.
• Supports the Operations Team or Plan with other duties as needed.
• Ability to engage staff and community partners.
• Pays attention to detail, and can meet deadlines / time management; independently works without close supervision.
• Understanding of medical care delivery and local market dynamics; familiar with Affordable Care Act.
• Strong interpersonal skills and conflict resolution skills with the ability to interface effectively both internally and externally with a wide range of people including members, community partners, outside vendors and other health plan staff.
• Excellent problem solving skills and professional judgment with effective follow through without prompt.
• Strong listening, verbal, presentation and written communication skills.
• Proficiency with Microsoft Word, Excel, Power Point and use of the internet.
People Management/Department Management/Business Unit Management:
• Assists with implementation of new or existing service line initiatives.
• Adheres to all local, state, and federal regulations.
• Participates as member of company.
• Responds proactively to Plan or departmental needs and concerns.
• Works well with others.
• Accepts constructive feedback, evaluates, and takes the appropriate steps to implement changes, if needed.
MINIMUM EDUCATION: High school diploma or GED.
PREFERRED EDUCATION: Some college.
MINIMUM EXPERIENCE: One (1) years of work experience in Managed Care Organization and CMS Marketplace.
PREFERRED EXPERIENCE: Three (3) years of work experience in Managed Care Organization and CMS Marketplace.