Health Plan Operations Coordinator - Aspire Health

Montage Health•El Dorado Hills, CA

About The Position

The Health Plan Operations Coordinator is responsible for supporting and coordinating the day-to-day operational functions of the health plan to ensure efficient, accurate, and compliant service delivery. This role coordinates and actively works across multiple teams, including provider services, claims, enrollment, and appeals and grievances. The coordinator monitors operational processes, resolves issues, analyzes data, and supports the operations as directed.

Requirements

Excellent verbal and written communication skills, including active listening.
Ability to operate phone, office and mail processing equipment required to fulfill position responsibilities.
Ability to operate spreadsheet, word processing programs and computer equipment required to fulfill position responsibilities.
Working knowledge of business operations.
Working knowledge of federal regulation specific to the administration of health and welfare plans, including CMS, ERISA, Department of Labor and Health and Human Services.
Ability to work with minimal supervision.
Readily adaptable to the changing needs of the business; able to manage multiple priorities; tolerance for ambiguity.
Ability to use sound judgement, identify next steps to be taken, and develop appropriate solutions.
Ability to collaborate with multiple parties to solve problems.
Proficient in the use of Microsoft Office Suite, Highly skilled at using the Internet.
Must learns effectively with computer-based and/or online training.
Demonstrates adaptability and openness to alternative solutions and flexibility when interacting with others, understanding their attitudes, needs, interests, and perspectives.
The ability to network and partner with all internal and external stakeholders including broad and diverse representation of private/public and traditional/non-traditional community organizations.
High school diploma; Associates degree, preferred.
Minimum 1 to 3 years experience in a healthcare or insurance industry setting.

Responsibilities

Provide administrative support to operational teams as requested.
Coordinate and support daily health plan operational activities to ensure timely, accurate, and compliant processing of business functions.
Assists with operational workflows related to member enrollment, eligibility, provider data management, claims processing and other core health plan functions.
Serve as a liaison between internal departments, providers, delegated entities, vendors, and external stakeholders to resolve operational issues.
Track, investigate, and resolve operational discrepancies while ensuring compliance with organizational policies and regulatory requirements.
Assist with implementing new operational processes, system enhancements, and workflow improvements.
Prepare, analyze, and distribute operational reports, dashboards, and performance metrics to support leadership decision-making.
Maintain accurate records and documentation in accordance with health plan policies and regulatory standards.
Support audits, accreditation activities, and regulatory reporting requirements.
Coordinate meetings, document meeting minutes, track action items, and follow up on operational initiatives.
Assist with implementation of new operational processes, regulatory requirements, and system enhancements such as user acceptance testing (UAT) and validating operational processes before implementation.
Identify opportunities for process improvement and recommend solutions to increase efficiency and quality.
Participate in cross-functional committees, organizational projects and strategic initiatives that support health plan operations and organizational goals.
Perform additional duties and special projects as assigned to support department leadership.