Job Description

Operations At EmblemHealth

Continuously and proactively assess and monitor enrollment and billing operations vendor performance to achieve contractual targets daily. Frequently interface with Membership and Billing Tower Leaders to continuously identify and communicate opportunities for improvement with enrollment and billing processes. Identify areas of improvements in operational areas, provide appropriate action plans, develop and implement performance analysis programs and metrics to improve operational efficiency. Direct day-to-day Enrollment and Billing vendor operations and establish seamless cadence with line management counterparts at each vendor.

Responsibilities

• Assess and monitor performance of Operations vendors for each core process to meet contractual requirements and align with the enterprise customer experience objectives.
• Conduct reviews, transactional audits, and compliance and operational procedure reviews.
• Work with various business partners to define, design and develop analytic solutions to improve optimization and identify and mitigate risks.
• Apply timely, accurate and consistent understanding of risk across the organization to predict and gauge operational risks.
• Analyze performance data to compare intended outcomes with actual outcomes.
• Evaluate quality controls to assess effectiveness in identifying errors in systems and processes.
• Prepare reports and presentation to communicate results to Operations management.
• Maintain meticulous audit and other assessment records; compare current information to baseline historical performance and track and trend over time.
• Document special variation events that impact performance as well as corrective action(s) taken to address issue(s).
• Communicate and collaborate with other Operations management stakeholders as needed to support overall enterprise quality and customer experience objectives.
• Support Operations Tower Leads as needed to conduct/complete ad-hoc assessments and assignments.

Qualifications

• BS or BA degree
• 3 5+ years of relevant experience in auditing and assessment activities (Required)
• Additional experience/specialized training/certifications may be considered in lieu of educational requirement (Required)
• Process subject matter expertise and work experience for functional Operations Tower (Required)
• Excellent collaboration skills and the ability to influence management decisions (Required)
• Strong auditing skills that be applied across all types of business problems (Required)
• Strong communication skills - verbal, written, presentation, interpersonal with all types/levels of audiences (Required)
• Proficient with MS Office - Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc. (Required)
• Working knowledge of applicable systems utilized by Operations groups (Required)

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