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Operations Project Consultant – Claims Resolution and Recovery Assessment Team

Phoenix, Arizona;

Job Description:

Responsibilities:

Responsible for completing assessments on any change within Claims Resolution and Recovery (CR&R) including mandates, provisional credit issuance, autopay thresholds, and automation rates. May include developing current and proposed process maps, outlining detail business requirements, assisting with grooming stories and measuring the outcome of the initiative. Ability to work independently and achieve goals with minimal direction.

This position requires development of strong professional relationships with the line of business leaders and business partner:

Key functions involve:

  • Pulling data from multiple claims systems via SQL
  • Analyzing data and making recommendations
  • Reviewing recommendation with the Sr. Leaders to gain approval
  • Working with business partners on detail requirements
  • Measuring benefit of project

Ensure inclusivity of key players within CR&R i.e. Forecasting, Capacity Plan, Staffing, and Business Continuity. Establish benchmark standard for successful analytical support and transparency to the Business.

  • Exhibits polished communication skills and presence
  • Present initiatives as appropriate to audience
  • Demonstrates personal resilience and an ability to lead through change
  • Creates workforce stability by cultivating an engaged, enthusiastic and team driven environment
  • Maintains the ability to simplify complex issues, and ensure audience engagement and understanding
  • Demonstrates a mature, poised, credible and confident demeanor that reassures peers and leadership
  • Leads by example with integrity maintaining focus on growth and development

Required to work from the primary work location listed when not in remote operating stance.       

Initially you may be required to work from home and/or remotely in this role:                                                                                           

  • Internet Service Provider at home (no public WiFi or Internet)                                                                  
  • Sufficient room to set up a laptop, monitor, keyboard and mouse                                                                      
  • Comfortable space to work for a full shift                                                                                              
  • Quiet, private and SECURE space in which to work                                                                                            

Enterprise Role Overview:

Responsible for medium - large projects for an operations department, product or business unit. Provides consulting expertise to line managers on productivity issues, analyzes market and operational impact in the business brought about by the project parameters. Researches and documents organizational reviews, workflow analysis, management and staff analysis. Develops project plans including estimates of cost and resources required. Defines project scope to others outside of operations that may become involved in or impacted by the project. Requires a thorough knowledge of the operations area.

Required Skills & Experience:

  • Proficiency in Data Mining and Data Analysis concepts
  • Presentation of data
  • Ability to pull claims data via SQL for assessment.
  • In-depth knowledge of EPIC, MSS, OMNI, CCMS, and other claim related production systems
  • Holistic understanding of the E2E process to provide strategic ad-hoc support to business partner
  • Excellent written and oral communication skill
  • Must work well in a team environment, as well as independently.
  • Strong ownership skills

Desired Skills & Experience:

  • Report development and management preferred
  • SQL, Excel, Access, and/or other data gathering experience preferred
  • Project management experience
  • Claim (Fraud and Billing Dispute) Experience

Job Band:

H5

Shift: 

1st shift (United States of America)

Hours Per Week:

40

Weekly Schedule:

Referral Bonus Amount:

0

Job Description:

Responsibilities:

Responsible for completing assessments on any change within Claims Resolution and Recovery (CR&R) including mandates, provisional credit issuance, autopay thresholds, and automation rates. May include developing current and proposed process maps, outlining detail business requirements, assisting with grooming stories and measuring the outcome of the initiative. Ability to work independently and achieve goals with minimal direction.

This position requires development of strong professional relationships with the line of business leaders and business partner:

Key functions involve:

  • Pulling data from multiple claims systems via SQL
  • Analyzing data and making recommendations
  • Reviewing recommendation with the Sr. Leaders to gain approval
  • Working with business partners on detail requirements
  • Measuring benefit of project

Ensure inclusivity of key players within CR&R i.e. Forecasting, Capacity Plan, Staffing, and Business Continuity. Establish benchmark standard for successful analytical support and transparency to the Business.

  • Exhibits polished communication skills and presence
  • Present initiatives as appropriate to audience
  • Demonstrates personal resilience and an ability to lead through change
  • Creates workforce stability by cultivating an engaged, enthusiastic and team driven environment
  • Maintains the ability to simplify complex issues, and ensure audience engagement and understanding
  • Demonstrates a mature, poised, credible and confident demeanor that reassures peers and leadership
  • Leads by example with integrity maintaining focus on growth and development

Required to work from the primary work location listed when not in remote operating stance.       

Initially you may be required to work from home and/or remotely in this role:                                                                                           

  • Internet Service Provider at home (no public WiFi or Internet)                                                                  
  • Sufficient room to set up a laptop, monitor, keyboard and mouse                                                                      
  • Comfortable space to work for a full shift                                                                                              
  • Quiet, private and SECURE space in which to work                                                                                            

Enterprise Role Overview:

Responsible for medium - large projects for an operations department, product or business unit. Provides consulting expertise to line managers on productivity issues, analyzes market and operational impact in the business brought about by the project parameters. Researches and documents organizational reviews, workflow analysis, management and staff analysis. Develops project plans including estimates of cost and resources required. Defines project scope to others outside of operations that may become involved in or impacted by the project. Requires a thorough knowledge of the operations area.

Required Skills & Experience:

  • Proficiency in Data Mining and Data Analysis concepts
  • Presentation of data
  • Ability to pull claims data via SQL for assessment.
  • In-depth knowledge of EPIC, MSS, OMNI, CCMS, and other claim related production systems
  • Holistic understanding of the E2E process to provide strategic ad-hoc support to business partner
  • Excellent written and oral communication skill
  • Must work well in a team environment, as well as independently.
  • Strong ownership skills

Desired Skills & Experience:

  • Report development and management preferred
  • SQL, Excel, Access, and/or other data gathering experience preferred
  • Project management experience
  • Claim (Fraud and Billing Dispute) Experience

Shift:

1st shift (United States of America)

Hours Per Week: 

40

Learn more about this role

Full time

JR-21016969

Manages People: No

Travel: Yes, 5% of the time

Manager:

Talent Acquisition Contact:

Referral Bonus: