Operational Excellence Analyst I (Claims experience preferred)

Job Summary :

The Operational Excellence Analyst I is responsible for oversight and monitoring of Operations regulatory and accreditation requirements as well as specific HEDIS initiatives. Claims experience is preferred.

Essential Functions :

• Oversight and monitoring of Operations regulatory requirements
• 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 / or Enrollment processes
• Generate monthly reporting, analyze 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
• Perform any other job duties as requested

Education and Experience :

Competencies, Knowledge and Skills :

Working Conditions :

Compensation Range :

$46,500.00 - $74,500.00 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 : Hourly

Competencies :

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 environment of belonging that welcomes and supports individuals of all backgrounds.

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