Operations Support Analyst

CAI•Newark, DE

3d•Onsite

About The Position

The Operations Support Analyst supports Delaware Medicaid operations as a full-time, fully onsite position in Newark, Delaware. The role serves as a subject matter expert in Delaware Medical Assistance policy, eligibility rules, and operational workflows, and acts as a bridge between policy, operations, and frontline staff to support accurate case processing, regulatory compliance, and quality customer service. The analyst maintains and updates standard operating procedures (SOPs), develops and delivers staff training, and serves as a lead resource for Customer Relations Unit (CRU), Change Report Center (CRC), and Help Desk functions. The analyst provides guidance on complex policy matters, maintains a centralized knowledge base, reviews and resolves client inquiries, processes reported changes, investigates escalated issues, and documents actions in case records and tracking systems. The role also identifies trends and opportunities to improve workflows, supports implementation of policy and process changes, and collaborates with operations teams, policy teams, and external stakeholders. Candidates must have work authorization that does not require sponsorship now or in the future.

Requirements

Deep knowledge of Medicaid or Medical Assistance policy and eligibility requirements, preferably within Delaware.
Experience with case processing, CRU, CRC, or similar customer support functions.
Strong analytical and problem-solving skills.
Experience creating training materials and delivering training sessions.
Exceptional attention to detail and commitment to documentation standards.
Ability to manage multiple priorities and respond effectively to time-sensitive requests.
Strong written and verbal communication skills.
Work authorization that does not require sponsorship now or in the future.
Ability to perform essential job functions consistent with ADA and other applicable federal, state, and local standards.
Ability to perform repetitive computer tasks using a mouse, keyboard, and monitor.

Nice To Haves

Experience working with Medicaid eligibility systems.
Experience handling escalated cases, Fair Hearing-related cases, or complex eligibility situations.
Process improvement or quality assurance experience.

Responsibilities

Serve as the primary expert in Delaware Medicaid policy, eligibility rules, and case management procedures.
Develop, review, and update SOPs to reflect policy changes and operational improvements, ensuring they accurately describe workflows across CRU, CRC, and Help Desk functions.
Monitor policy updates and assess their operational impact across teams.
Provide staff with guidance and clarification on complex or ambiguous policy scenarios.
Design training materials, including guides, job aids, presentations, and SOPs, and deliver onboarding and ongoing training.
Identify knowledge gaps through case trends, errors, and escalations, and address them through targeted training.
Maintain a centralized knowledge base of policies, procedures, and best practices.
Review and resolve client inquiries concerning case determinations, case status, and eligibility; investigate escalated issues and ensure timely, accurate resolution.
Thoroughly document actions in case comments, records, and tracking systems, including calls, correspondence, and eligibility changes.
Coordinate responses with prior caseworkers or leadership when necessary, including matters involving recent determinations and Fair Hearings.
Communicate clearly and completely with CRU and CRC stakeholders about inquiries, reported changes, and outcomes.
Process client-reported changes to household composition, income, and contact information; verify changes using appropriate systems and supporting documentation, and accurately confirm and process eligibility impacts.
Lead communication with the Help Desk on technical issues, including duplicate case or MCI numbers; submit and track tickets, accurately re-enter client information when needed, and respond to Help Desk inquiries affecting staff.
Review case records, benefits, and case history before taking action to ensure accuracy and compliance.
Update tracking tools and case logs to reflect actions and outcomes.
Identify trends in errors, escalations, and processing delays and recommend process improvements.
Serve as a resource for escalated and complex Medicaid cases.
Identify opportunities to streamline workflows and improve operational efficiency.
Support leadership in implementing new processes, tools, and policy updates.
Collaborate with operations teams, policy teams, and external stakeholders to support program objectives.