Job Summary:

The Health Plan Operations Analyst I reviews and analyzes the effectiveness and efficiency of existing market operation processes and systems and participates in development of solutions to improve or further leverage these functions.

Essential Functions:

• Participates in the development of new market operation initiatives from concept to implementation and provide statistics measuring progress throughout

• Market process issues
  • ID card issue resolving wrong co-pay information.
  • Helping to align the mismatches in our Single Case Agreements where policy does not match market direction and operations is doing something completely different (project facilitation).
• Marketplace state competitive analysis. Bringing existing membership numbers, eligibility numbers and local competitive intelligence together to facilitate and make decisions with market president.
• Assist Market President, BD and Operations with project management or NC Medicaid contract

• Collect and analyze data in support of business case creation and realization
• Contribute to ensuring operational effectiveness by assisting in the development of strategic plans for market operations, including business, financial, and operational goals and objectives
• Assist in the review of reports and data for pattern identification, special cause variation identification, trend analysis, or other techniques; prepare and deliver summaries, recommendations, or alternatives of the analyzed information
• Develop, document and perform testing and validation as needed
• Work with peers to achieve cross-functional capability with project execution and subject matter expertise
• Participates in the discussions of challenging the standard thinking with new ideas, approaches, and solutions which focus on process improvement and growth
• Perform any other job duties as requested

Education and Experience:

• Bachelor’s degree in Engineering, Business, Finance, Economics or related field or equivalent years of relevant work experience is required
• Minimum of one (1) years of analytical experience is preferred
• A minimum of three (3) years of health care operations or project management experience is preferred

Competencies, Knowledge and Skills:

• Advanced proficiency in Microsoft Office Suite to include Word, Excel, Access and PowerPoint
• Familiar with a variety of analysis concepts, practices and procedures
• Excellent written and verbal communication, facilitation and presentation skills
• Strong interpersonal skills and high level of professionalism
• Effective listening and critical thinking skills
• Effective problem solving skills with attention to detail
• Ability to work independently and within a team
• Strong analytical skills
• Ability to create and maintain excellent working relationships
• Time management skills, ability to develop, prioritize and accomplish goals with a sense of urgency
• Ability to effectively interact with all levels of management within the organization and across multiple organizational layers
• Ability to multi-task and remain flexible during organizational and/or business changes

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for long periods of time
• May be required to travel occasionally

Compensation Range:

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/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

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 inclusive environment that welcomes and supports individuals of all backgrounds.