Operations Manager

Job Description:

Manages and is responsible for a specific operational team with oversight of multiple products/lines of business within the organization. Ensures the team is providing superior customer service and achieving departmental goals.

Schedule

• 8 am to 5 pm  Normal business hours.  Monday - Friday
• Hybrid position

Essential Functions

• Manages team of operations supervisors and trainers responsible for claims or customer service. Monitors administrative budget of department.
• Provides oversight to employment functions including hiring, performance management, constructive discipline and termination. Fosters employee and team morale. Educates, trains, coaches, problem solves and coordinates the ongoing development of skills in supervisors, trainers and team members.
• Oversees customer service and/or management of claims, ensuring issues are escalated and resolved efficiently and claims are processed accurately and proficiently according to all applicable state and federal regulations and performance guarantees. Develops, administers, and reports service quality key indicators in compliance with Operations and government requirements.
• Implements and operationalizes new products, new groups, benefit enhancements, and benefit changes. Implements new regulations, requirements and policies.
• Develops effective relationships with other departments to implement and operationalize workflows, key contacts, etc. to ensure the delivery of superior service and that financial and customer service standards are met and exceeded.
• Ensures claims and customer service system integrity, coordinates system changes, and upgrades system for improvements and that Operations is compliant with internal, NCQA and regulatory agency requirements.
• Develops, reviews, and updates Operations policy manuals, training materials / tools, member payment summaries, and other materials.
• Recommends, develops and implements innovative strategies for retention of existing members, addition of new members, containing dental and medical costs, improving efficiency, and customer satisfaction and service.

Skills

• Accountability
• Business Interpersonal Communication
• Strategic Decision Making
• Group Problem Solving
• Innovation
• Strategic Decision Making
• Leadership
• Metrics Development
• Process Improvements
• Project Management

Minimum Qualifications

• Bachelor's Degree in a Business or Health Care related field. Degree must be obtained through an accredited institution. Education is verified.

- or -

• Demonstrated professional health insurance.

- and -

• Demonstrated experience in a management/supervisory position working with the administration of managed care products with emphasis on benefit design, systems structures or applications, payment arrangements, claims processing and administration and customer service procedures to obtain a strong knowledge of state and federal regulations, statutes, laws, HIPAA, NCQA and contractual requirements related to managed care.

- and -

• Demonstrated intermediate knowledge with Facets or similar claims adjudication system.

Preferred Qualifications:

• Master's Degree in a business or healthcare related field.
• Effective coach and team builder.
• Experience in process improvement methodologies to gain operational efficiencies.
• Strong organizational, data gathering, and data analysis skills.
• Excellent oral, written, and interpersonal communication skills.
• Excellent problem solving, negotiation, and process improvement skills.

Physical Requirements:

Physical Requirements

• Ongoing need for employee to see and read information, labels, documents, monitors, identify equipment and supplies, and be able to assess customer needs.
• Frequent interactions with providers, colleagues, customers, members and visitors that require employee to verbally communicate as well as hear and understand spoken information, needs, and issues quickly and accurately.
• Manual dexterity of hands and fingers to manipulate complex and delicate supplies and equipment with precision and accuracy. This includes frequent computer use for typing, accessing needed information, etc.
• Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.

Location:

SelectHealth - Murray

Work City:

Murray

Work State:

Utah

Scheduled Weekly Hours:

40

The hourly range for this position i