Operations Analyst

Community Health Plan of Washington•Seattle, WA

12d

About The Position

Responsible for sustaining processes and executing process improvement and quality monitoring within Claims Operations and the business processes impacted by Operations data and systems. This position is temporary, scheduled to end in June of 2027. To be successful in this role, you: Bachelor's degree in health care or related field or an equivalent combination of education and highly relevant experience required. Minimum three (3) years' managed care/health plan operations experience required, with proven broad knowledge and execution of quality improvement methods and tools. Minimum two (2) years' business/operations analysis experience in a related field required. Background in Medicaid and Medicare claims adjudication, benefits configuration, claims coding, electronic data interface, and encounter data reporting preferred. Experience in managed care/health plan operations and business/operations analysis experience in a related field.

Requirements

Bachelor's degree in health care or related field or an equivalent combination of education and highly relevant experience required.
Minimum three (3) years' managed care/health plan operations experience required, with proven broad knowledge and execution of quality improvement methods and tools.
Minimum two (2) years' business/operations analysis experience in a related field required.
Knowledge of the healthcare industry, which includes claims adjudication, benefits configuration, claims coding, electronic data interface, and/or encounter data reporting.
Knowledge of quality improvement methods and tools.
Team facilitation skills.
Project management Skills
Communication skills, both verbal and written.
Technical, analytical and process documentation skills
Ability to multi-task, prioritize, work under pressure as well as work with other departments and people at all levels within the organization.
Ability to gather and assess data, problem-solve, and consult/follow up with stakeholders.
Complete and successfully pass a criminal background check
Criminal History: includes review of criminal convictions and probation.
Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency
Vaccination requirement (CHPW offers a process for medical or religious exemptions)

Nice To Haves

Background in Medicaid and Medicare claims adjudication, benefits configuration, claims coding, electronic data interface, and encounter data reporting preferred.
Experience in managed care/health plan operations and business/operations analysis experience in a related field.

Responsibilities

Responsible for State and CMS claims benefit interpretation and application, and oversight of system benefit and pricing configuration.
Gather business requirements for claims benefit configuration to support system updates, enhancements and implementation of new products.
Facilitate the development and execution of user acceptance scenarios and scripts for testing of system changes, implementations, and enhancements.
Peer review and support system enhancements and configuration of vendor systems.
Provide support for electronic data interchange (EDI) data files and CHPW web-based interfaces.
Interpret, monitor, and ensure compliance with state, CMS, OIC requirements; pricing, audit performance, encounter data submissions/reporting, and vendor management.
Other duties as assigned.

Benefits

Medical, Prescription, Dental, and Vision
Telehealth app
Flexible Spending Accounts, Health Savings Accounts
Basic Life AD&D, Short and Long-Term Disability
Voluntary Life, Critical Care, and Long-Term Care Insurance
401(k) Retirement and generous employer match effective the 1st of the month following or coinciding with the employee's start date
Wellness programs (Employee Assistance Program and Mental Fitness app)
Financial Coaching, Identity Theft Protection
Paid Time Off (PTO) including PTO accrual starting at 17 days per year
40 hours Community Service volunteer time
10 standard holidays, 2 floating holidays
Compassion time off, jury duty
A monthly stipend to offset work-from-home expenses for roles that are 100% remote