Job Summary:

The Service Process Analyst I, Medicaid Focused identify opportunities for improvement in Customer Care's business processes and recommends projects aimed at enhancing quality, reducing costs, and promoting automation and call reduction. This position assists with effective implementation of new procedures, assists in conducting process audits and root cause analyses, and acts as a resource for assigned markets/products.

Essential Functions:

• Manage a minimum of three lower complexity projects concurrently under the guidance of a manager.
• Act as key resource for assigned markets/products, supporting the development and maintenance of policies, processes, and training materials to ensure compliance with contractual, regulatory, accreditation, and quality standards.
• Identify and escalate obstacles, inefficiencies, and opportunities for automation or reduction of inbound volume/AHT.
• Create comprehensive process documentation and guidelines, including standard operating procedures and workflow diagrams.
• Collaborate with stakeholders in other departments to establish and enhance workflows to and from Customer Care.
• Assess incoming service change requests engaging with stakeholders to discuss requirements and prioritize actions, ensuring optimal use of time and resources.
• Assist with audits, conversations with regulators, and cross-functional conversations requiring a Customer Care subject matter expert.
• Contribute content for Voice of the Customer report, Status Reports, and other communications to Senior. Leadership.
• Perform any other job-related instructions as requested.

Education and Experience:

• High School Diploma is required
• Bachelor’s degree or equivalent years of relevant work experience is preferred
• Proven experience in utilizing data to inform and support recommendations is required.
• A minimum of one (1) year of customer service experience related to healthcare payer dealing with both members and providers is required

Competencies, Knowledge and Skills:

• Demonstrates a high level of accountability as it relates to ensuring Customer Care has all required processes and tools
• Proficient use of Microsoft products including Word, Excel, PowerPoint, Visio, SharePoint, and Dynamics 365 is required.
• Experience with NICE CXOne is preferred.
• Strong interpersonal, active listening and critical thinking skills
• Ability to document and maintain system requirements including process flows is required
• Ability to keep current on business processes/technologies through self-directed learning
• Excellent written and verbal communication skills
• Ability to develop, prioritize and accomplish goals

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time.
• Hybrid Position: 2-3 days/week in Dayton office if home address is within 45 miles. Preferred days are Tuesday, Wednesday, & Thursday.
• Ability to travel as required by the needs of the business

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.