Operations Expert (US)

Elevance Health • Mayagüez, PR

1d • Hybrid

About The Position

Operations Expert Location: This role requires associates to be in-office [1-2] days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of remote work, promoting a dynamic and adaptable workplace. This position will be based in PR-MAYAGUEZ, PR-2 KM 159 STE 301. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Schedule: This position will work 5 days per week on 8-hour shifts. Candidate should have availability from Monday through Friday within the operational hours of 8:00 am - 8:00 pm (EST). Additional hours, including weekends or holidays, may be required based on operational needs. Carelon Global Solutions (CGS), a fully owned subsidiary of Elevance Health, is a healthcare solutions company that is simplifying complex operational processes to improve the health of the healthcare system. Our Puerto Rico location operates a bilingual Spanish and English call center, providing clear and precise answers to customer queries. The Operation Expert is responsible for providing technical direction, guidance and resources to operations, claims, customer service, or membership associates on a day-to-day basis. The work environment as non-telephonic and production-based, with associates supporting work primarily through electronic queues and written/digital channels. How you will make an impact. Primary duties may include, but are not limited to: Serves as a first line resource for operation associates for workflow and technical related processes. Provides operational training; assists associates by answering day-to-day technical questions. Encourages a teamwork environment; monitors inventory to ensure workflow remains uninterrupted. Handles complex case research and resolution; reviews, interprets and maintains records of service level, quality, accuracy, and productivity. Reviews department policy and procedure manuals for accuracy. works with training department to ensure procedures and policies are accurate and complete. Associates in this role are expected to have the ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers. Additional expectations to include but not limited to: Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment. Strong verbal and written communication skills, both with virtual and in-person interactions. Attentive to details, critical thinker, and a problem-solver. Demonstrates empathy and persistence to resolve caller issues completely. Comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts. Associates in this role will have a structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary. Performs other duties as assigned.

Requirements

• Requires HS diploma or equivalent and a minimum of 5 years related experience which includes a minimum of 3 years of directly related experience and expertise with company relevant automated processing systems; or any combination of education and experience which would provide an equivalent background.
• Associates in this role are expected to have the ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers.
• Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment.
• Strong verbal and written communication skills, both with virtual and in-person interactions.
• Attentive to details, critical thinker, and a problem-solver.
• Demonstrates empathy and persistence to resolve caller issues completely.
• Comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts.
• Associates in this role will have a structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary.

Nice To Haves

• Previous leadership experience is preferred.
• Prior experience providing coaching/training and acting as a workflow/SME resource is preferred.
• Fully Bilingual (English & Spanish). Must be able to write, read and speak both languages in a proficiency level.
• For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Responsibilities

• Serves as a first line resource for operation associates for workflow and technical related processes.
• Provides operational training; assists associates by answering day-to-day technical questions.
• Encourages a teamwork environment; monitors inventory to ensure workflow remains uninterrupted.
• Handles complex case research and resolution; reviews, interprets and maintains records of service level, quality, accuracy, and productivity.
• Reviews department policy and procedure manuals for accuracy.
• works with training department to ensure procedures and policies are accurate and complete.
• Performs other duties as assigned.

Benefits

• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees