Operations Manager-2

PGBA•Florence, SC

12h•Onsite

About The Position

Manages the daily activities of a multi-functional area. Responsible for monitoring productivity, attendance and quality of work produced. Responsible for motivating associates to meet individual and departmental goals. PGBA – one of BlueCross BlueShield's South Carolina subsidiary companies. This position is full-time (40 hours/week) Monday-Friday from 8:00am-5:00pm. This role is located on-site at 200 N Dozier Blvd, Florence, SC 29501.

Requirements

Bachelor’s degree
Strong management, organization, communication, decision-making, and analytical skills.
Excellent customer service skills.
Strong presentation skills and basic business math proficiency.
Knowledge of applicable laws and regulations pertaining to business unit operations.
Microsoft Office.

Nice To Haves

3 years-of related health or managed care industry work experience.
1 year-of management experience OR 1 year of equivalent military experience in grade E4 or above.
Ability to use complex mathematical calculations.
Knowledge of mathematical or statistical concepts.
Proficient in database software.
Knowledge of Provider Data Management system.

Responsibilities

Direct and supervise claims/documents processing and support team associates to ensure claims/documents are processed in a timely and efficient manner to maintain contract compliance standards.
Prepare and analyze reports of pending and processed documents, claims, adjustments and reprocesses, and quality audits of claims/documents that measure level of performance of the team.
Administer and oversee quality control procedures and ensure compliance of all corporate and contract required guidelines.
Select and maintain a well-trained staff.
Identify potential education and system issues.
Establish and maintain a high level of customer service with all internal and external customers.
Direct and supervise the customer service associates to ensure that all correspondence and telephone inquiries are processed in a timely and efficient manner to maintain contract compliance standards.
Select and maintain a well-trained staff.
Identify potential education and system issues.
Participate as project leader on policy changes, quality improvements initiatives and system change efforts, while ensuring corporate, contractor, and department policies and procedures are administered timely, consistently and accurately.
Identify system errors and process/quality improvement opportunities, initiate work requests, and serve as the customer project lead to ensure accurate implementation.
Assist in budget preparation and monitor expenses related to the budget.