Job description

Your Role The Operations Specialist supports claims operational teams by performing end-to-end testing to identify defects of new code being introduced to the production environment. Creating test cases that will prevent or identify incorrect logic, claims downstream impacts, output concerns or other claim processing issues. The Operations Specialist will report to the manager. In this role, you will work both independently and collaborate within the team and other teams to develop solutions that will enhance and create efficiencies in accordance with policies and provisions set forth by state, federal or local entities. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning. Your Work In this role, you will: • Perform end to end testing on service enhancements, projects, mandates, and strategic initiatives. Providing through testing on all requirements to ensure accuracy of requirements. • Act as subject matter expert and review operational workflows, identifying problems and acting as a SME to inform improvements, modifications, and enhancements. • Track and communicate workflow and system changes to appropriate resources. • Review systems and applications and recommend system edits/changes as needed. • Notify appropriate department managers about issues and problems in operational workflow requiring immediate attention. • Participate as a subject matter expert to inform the development of written guidelines. and documents problems as needed. • Research source material and evaluate process flows. • Collaborate cross-functionally with internal and external teams. Your Knowledge and Experience • Bachelor’s degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree • Understanding of healthcare claims processing required • Experience with user acceptance testing preferred • Knowledge and experience of Agile methodology, including Jira preferred • Ability to work independently • Requires critical thinking and problem solving • Strong prioritization skills Hybrid This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week. Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need. The Operations Specialist supports claims operational teams by performing end-to-end testing to identify defects of new code being introduced to the production environment. Creating test cases that will prevent or identify incorrect logic, claims downstream impacts, output concerns or other claim processing issues. The Operations Specialist will report to the manager. In this role, you will work both independently and collaborate within the team and other teams to develop solutions that will enhance and create efficiencies in accordance with policies and provisions set forth by state, federal or local entities.

Requirements

Must-haves

Perform end to end testing on service enhancements, projects, mandates, and strategic initiatives. Providing through testing on all requirements to ensure accuracy of requirements.
Act as subject matter expert and review operational workflows, identifying problems and acting as a SME to inform improvements, modifications, and enhancements.
Track and communicate workflow and system changes to appropriate resources.
Review systems and applications and recommend system edits/changes as needed.
Notify appropriate department managers about issues and problems in operational workflow requiring immediate attention.
Participate as a subject matter expert to inform the development of written guidelines. and documents problems as needed.
Research source material and evaluate process flows.
Collaborate cross-functionally with internal and external teams.
Your Knowledge and Experience
Bachelor’s degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree
Understanding of healthcare claims processing required
Ability to work independently
Requires critical thinking and problem solving
Strong prioritization skills
Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

Nice-to-haves

Experience with user acceptance testing preferred
Knowledge and experience of Agile methodology, including Jira preferred

Application prep

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Keywords to mirror

agilejira

Platform: oracle-cloud
Effort: medium

Benefits

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