Operations Specialist, Senior (Part-Time)

Your Role

This is a part-time position supporting the Post Service Review team reviews claims for benefits, medical necessity, coding accuracy and medical policy compliance. The Operations Specialist, Senior will report to the Senior Manager, Post Service Team. In this role you will be responsible for problem solving issues, testing, training and updating documentation as needed. You will work to enhance the department's operations with efficiency and attention to detail/quality.

Your Work

In this role, you will:

• Tracks daily inventory, trends, and reports any risks with inventory, system, or staff to the Manager.
• Provide leadership in tracking and communicating workflow and system changes to appropriate skill levels of unit staff.
• Develop and generate accurate reports.
• Provides measurable input into new products, processes, standards and/or operational plans that will have some impact on the achievement of overall function results.
• Responsible for proactively improving upon existing processes and systems using significant conceptualizing, reasoning, and interpretation. Results may serve as precedent for future decisions.
• Conducts extensive investigation, critical thinking to understand root cause of problems related to inventory management.
• Has responsibilities for communicating with parties' external to the organization, which may include vendors.
• Requires ability to communicate with executive leadership regarding matters of significant importance to the organization.
• Generally, conducts briefings with senior leaders within the job function.
• Responsible for making moderate to significant improvements of processes, systems or products to enhance performance of job functions.
• Develop and evaluates tools and materials that improve operating efficiency and accuracy related to the post service review process, both internal to the team and across the department and in conjunction with external vendors used to manage and maintain the formulary for all lines of business.
• Participate as a subject matter expert in the development of written guidelines and documents desk level procedures and policy and procedures.
• Occasional business travel possible.
• Other duties as assigned.

Qualifications

Your Knowledge and Experience

• Requires a college degree or equivalent experience and minimum 5 years of prior relevant experience (e.g., claims, customer service)
• Excellent analytical and problem-solving skills.
• Strong skills in standard Microsoft Office applications (e.g., Excel, Word, Outlook, Access).
• Strong coordination and interpersonal skills working in a matrixed environment with multiple stakeholders.
• Ability to identify and resolve complex problems related to automated systems and operations within functional area.
• Broad knowledge of technical and operational practices in the claim's processing system is preferred.