About this role
Job Track Description:
- Performs tasks based on established procedures.
- Uses data organizing and coordination skills to perform business support or technical work.
- Requires vocational training, certifications, licensures, or equivalent experience.
General Profile
- Has advanced, specialized expertise within a range of analytical or operational processes.
- Completes assignments and facilitates the work of others.
- May coordinate assignments beyond work area.
- Proposes improvements to processes and methods.
- Acts as a lead, coordinating the work of others, but is not a supervisor.
- Works autonomously within established procedures.
Functional Knowledge
- Has developed skills in a range of processes, procedures, and systems.
- Acts as a technical expert in some areas.
Business Expertise
- Understanding of how best teams integrate and work together to achieve company goals.
Impact
- Impacts a team, by example, through the quality service and information provided.
- Suggests enhancements to work procedures and practices to improve efficiency.
Leadership
- Serves as a team lead.
- May allocate work to team members.
- Provides subject matter guidance to junior team members.
Problem Solving
- Provides solutions to atypical problems with little or no precedent.
Interpersonal Skills
- Communicates information and ideas effectively.
- Uses tact and diplomacy when dealing with others.
Responsibility Statements
- Facilitates quantitative project KPIs such as service level so that intraday and intraweek operational KPIs are met and optimized.
- Ensures that published schedules appropriately meet organization and project-specific targets (KPIs) within a set policy.
- Monitors intraday actuals against forecasted planning parameters and applies corrective actions to address negative deviations.
- Re-forecasts planning parameters based on actuals.
- Updates intraday schedules to best meet requirements for upcoming intervals.
- Records events and incidents that influence forecasts and KPI realization for impact review and future planning.
- Accepts and maintains published schedules by adjusting to accommodate changes to available resources or client requirements.
- Manages operations across several health plan functions, including plan operations, member/provider services, claims, implementation and grievances/appeals.
- Performs other duties as assigned.
- Complies with all policies and standards.