Title: Operations Specialist
Location:Philadelphia, PA
Type: Contract
Our client is seeking an Operations Specialist.
Key Accountabilities: - Audit, analyze, test, document decisions and actions, and interface with internal and external areas from inception to conclusion for assigned projects and tasks.
- Identify and communicate opportunities for process improvements and automation by analyzing current policies, procedures, and processes.
- Troubleshoot and provide problem resolution support for issues related to internal and external audits, adjustments, and accumulators, engaging subject matter experts as needed.
- Make decisions based on standard policies and operating procedures.
- Consult with management and obtain approval before deviating from standard policies and operating procedures.
- Use prescribed guidelines or policies to analyze and resolve problems.
- Proactively monitor and analyze claim and accumulator transaction activity for quality, accuracy, mapping issues, and adherence to regulatory compliance requirements and performance standards.
- Monitor system health throughout the day, supporting real-time transactions.
- Identify data for potential areas of failure and work on long-term solutions.
- Act as a liaison between other departments and delegates related to internal/external audits, member/group complaints raised, etc.
- Create accurate claims reporting for internal and external customers.
- Collaborate effectively and build solid working relationships with internal customers, cross-functional internal departments, external vendor partners, and clients.
- Coordinate with Trading Partners and account personnel to resolve claim and accumulator issues.
- Provide business validation of testing results related to claims reporting, encounter data files, accumulator files.
- Identify opportunities for process improvement and efficiencies to reevaluate processes and workflows.
- Implement temporary fix to resolve accumulator issues while also collaborating on a permanent fix.
Required Skills: - Bachelor of Science in Accounting, Computer Science, Information Systems, or Information Technology is preferred.
- Demonstrates strong organizational, analytical, and interpersonal skills with detail-oriented focus.
- Demonstrates computer proficiency, including but not limited to, Microsoft Office Suite - Excel, Outlook, and SQL Server Management Studio.
- Demonstrates MS Excel proficiency with the ability to create formulas, VLOOKUP, and pivot tables, and analyze data.
REQ-001425