The Senior Operations Analyst is responsible for identifying project process changes and identifying & implementing process improvements in conjunction with the Claims Management Team. This includes all updates from key project teams, business requirements documents, department's policies & procedure, job aids, desktop procedures, etc. The person in this role must be committed to the successful implementation of key corporate projects and helping the Claims Department to improve the customer experience it provides to internal and external customers.
The ideal candidate has a large claims background in an HMO/health insurance setting.
Principal Duties and Responsibilities: * Represents the Claims Department in process changes, corporate project related meetings as appropriate. For example, Children's Referral Project, Novologix, Retro enrollment.
* Alternate to the Claims Solutions Manager in representing the department.
* Identifies system deficiencies and recommends workaround processes.
* Works collaboratively with the Management Team to improve the efficiencies of the department via process review and improvements.
* Collaborate with corporate training members and subject matter experts (SMEs) to assure the development of learning resources, visual aids and presentations to create and continuously improve the department's ability to understand and implement new projects, significant process changes, or new products.
* Helps to create and maintain source documentation (desktop procedures, job aids, etc) on SharePoint by participating in meetings as it relates to claim processing regarding new or changed processes, corporate initiatives and resulting system changes.
* Identify business process improvement opportunities and escalate the potential improvement appropriately. Identify improvements in the content management tools to create the appropriate resources for representatives to access information to assist the member/provider.
* Demonstrate commitment to providing customer-focused quality service.
* Hold self and others accountable to meet commitments.
* Ensure diversity, equity, and inclusion are integrated as a guiding principle.
* Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
* Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.
* Other duties as assigned with or without accommodation. Education
- Bachelor's Degree Analysis required or Bachelor's Degree Related Field of Study required
Can this role accept experience in lieu of a degree?
Yes Experience
- Experience working with data, preferably healthcare data 2-3 years required
Knowledge, Skills and Abilities
- Healthcare knowledge, particularly as it pertains to electronic medical record data, is preferred but not required.
- Working knowledge of relational databases, SQL, data visualization, and Business Intelligence tools such as Tableau.
- Knowledge and application of statistical analyses, including variance analysis and statistical significance, are preferred.
- Project management skills and/or experience are a plus.
- Proficiency with Microsoft Office Suite, including Word, Excel and PowerPoint.
Physical Requirements
- Standing Occasionally (3-33%)
- Walking Occasionally (3-33%)
- Sitting Constantly (67-100%)
- Lifting Occasionally (3-33%) 20lbs - 35lbs
- Carrying Occasionally (3-33%) 20lbs - 35lbs
- Pushing Rarely (Less than 2%)
- Pulling Rarely (Less than 2%)
- Climbing Rarely (Less than 2%)
- Balancing Occasionally (3-33%)
- Stooping Occasionally (3-33%)
- Kneeling Rarely (Less than 2%)
- Crouching Rarely (Less than 2%)
- Crawling Rarely (Less than 2%)
- Reaching Occasionally (3-33%)
- Gross Manipulation (Handling) Constantly (67-100%)
- Fine Manipulation (Fingering) Frequently (34-66%)
- Feeling Constantly (67-100%)
- Foot Use Rarely (Less than 2%)
- Vision - Far Constantly (67-100%)
- Vision - Near Constantly (67-100%)
- Talking Constantly (67-100%)
- Hearing Constantly (67-100%)
Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.
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Mass General Brigham Health Plan
Feb 21, 2025