Skills & Competencies for Health Insurance Operations Manager

Health Insurance Operations Manager job profile

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JOB SUMMARY for Health Insurance Operations Manager

Manages and maintains daily health insurance operations in multiple service areas, including account installation, implementation, client support, contract administration, claim processing, and enrollment and eligibility.

JOB RESPONSIBILITIES for Health Insurance Operations Manager

Handles and settles complicated customer service issues which can not be resolved by lower level staff. Monitors performance of each service area.

Health Insurance Operations Manager SALARY RANGE

BASE 50%
$111,652
TOTAL 50%
$123,931
Job Level
M02
Job Code
HC07000625
Education/Degree
Bachelor's Degree
Reports To
Senior Management or Director

Health Insurance Operations Manager Skills and Competencies List

Proficiency Levels and Behavioural Indicators
Salary.com identifies five increasing levels of proficiency for each skill/competency. Some jobs require only a relatively low level of proficiency in each skill/competency, while other jobs will require a more advanced level of proficiency in the same skill/competency. These levels rate the degree of proficiency (skill level, expertise) we expect the incumbent to perform in the given skill/competency for the given job. Note that we intentionally do not associate timeframes or years of experience in performing the skill/competency because that can be misleading. Proficiency levels identify what the incumbent knows and can do rather than how long they have been doing it. Also, note that the proficiency levels are cumulative, e.g., a level 4 proficiency implies the ability to perform all the behaviors at the lower levels.
Check each Health Insurance Operations Manager skill and competencie below to view definitions.
INDUSTRY COMPETENCIES JOB FAMILY COMPETENCIES CORE COMPETENCIES
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6 hard skills or competencies (industry competencies) for Health Insurance Operations Manager

1 Industry Competency – Insurance Industry
Proficiency Level -3
Skill definition-Applying knowledge of the insurance industry to provide risk management services and protection to various individuals from financial loss.
Level 1 Behaviors
(General Familiarity)
Describes the current systems and scope of services provided by insurance organizations.
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Level 2 Behaviors
(Light Experience)
Follows industry best practices when preparing reports that detail risk assessment findings in insurance claims.
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Level 3 Behaviors
(Moderate Experience)
Identifies cost-effective solutions to address regulatory compliance challenges in insurance services.
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Level 4 Behaviors
(Extensive Experience)
Facilitates discussions with agents and underwriters on evolving exposures and risk management practices.
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Level 5 Behaviors
(Mastery)
Designs and executes innovative strategies and techniques to optimize the claims-handling process.
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2 Industry Competency – Insurance Legal and Regulatory Environment
Proficiency Level -3
Skill definition-Creating, executing, and adhering to state and federal laws governing insurance operations to ensure financial security and consumer protection.
Level 1 Behaviors
(General Familiarity)
Describes the basic structure of insurance legal and regulatory environment.
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Level 2 Behaviors
(Light Experience)
Complies with insurance legal and regulatory principles to safeguard the rights and interests of the insured.
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Level 3 Behaviors
(Moderate Experience)
Analyzes existing legal and regulatory standards to address errors affecting insurance policies.
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Level 4 Behaviors
(Extensive Experience)
Improves legal procedures for licensing intermediaries or producers to prevent penalties.
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Level 5 Behaviors
(Mastery)
Designs compliance strategies and programs to prevent violations of statutes, regulations, and policies.
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3 Health Insurance Operations Manager - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Health Insurance Operations Manager
Proficiency Level - 4
5 Competency for - Health Insurance Operations Manager
Proficiency Level - 5

1 general skill or competency (Job family competency) for Health Insurance Operations Manager

1 Job Family Competencies – Vendor Management
Proficiency Level -3
Skill definition-Controlling costs, driving service excellence, and mitigating risks to gain increased value from their vendors.
Level 1 Behaviors
(General Familiarity)
Documents all the vendor management benefits and challenges.
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Level 2 Behaviors
(Light Experience)
Gathers and compiles vendors’ quotations for management review and approval.
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Level 3 Behaviors
(Moderate Experience)
Manages existing vendor relations to ensure compliance and risk management.
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Level 4 Behaviors
(Extensive Experience)
Develops and implements a contract management process to verify vendors adhere to contract terms and conditions.
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Level 5 Behaviors
(Mastery)
Creates and leverages vendor management key performance indicators to measure internal effectiveness and performance.
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3 Health Insurance Operations Manager - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Health Insurance Operations Manager
Proficiency Level - 4
5 Competency for - Health Insurance Operations Manager
Proficiency Level - 5

11 soft skills or competencies (core competencies) for Health Insurance Operations Manager

1 Core Competencies – Budgeting
Proficiency Level -2
Skill definition-Applying specific policies, tools and practices to plan and prepare projected revenues, expenses, cash flows, and capital expenditures.
Level 1 Behaviors
(General Familiarity)
Describes the concepts and principles of budgeting operations.
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Level 2 Behaviors
(Light Experience)
Assists in developing and improving budgeting models, plans, and strategies.
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Level 3 Behaviors
(Moderate Experience)
Compares planned budgets vs. actual expenditures, identifies, reports, and explains variances.
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Level 4 Behaviors
(Extensive Experience)
Determines system capabilities and needs to improve the process for financial budgeting.
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Level 5 Behaviors
(Mastery)
Develops financial models to support the strategic improvement of our budgeting processes.
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2 Core Competencies – Planning and Organizing
Proficiency Level -3
Skill definition-Managing and prioritizing resources and workloads by creating well-organized plans to attain organizational goals and objectives.
Level 1 Behaviors
(General Familiarity)
Compiles a list of all the traits of effective planning to help finish the assigned tasks.
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Level 2 Behaviors
(Light Experience)
Classifies assigned tasks based on the level of importance to ensure organized workload completion.
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Level 3 Behaviors
(Moderate Experience)
Defines and translates objectives into specific plans to ensure understanding of organizational goals.
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Level 4 Behaviors
(Extensive Experience)
Delivers training sessions to foster and maximize solid planning and organization capabilities.
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Level 5 Behaviors
(Mastery)
Champions the adoption of business intelligence systems to achieve planning and organization goals.
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3 Health Insurance Operations Manager - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Health Insurance Operations Manager
Proficiency Level - 4
5 Competency for - Health Insurance Operations Manager
Proficiency Level - 5

Summary of Health Insurance Operations Manager skills and competencies

There are 6 hard skills for Health Insurance Operations Manager, Insurance Industry, Insurance Legal and Regulatory Environment, Health Insurance, etc.
1 general skills for Health Insurance Operations Manager, Vendor Management.
11 soft skills for Health Insurance Operations Manager, Budgeting, Planning and Organizing, Coordination, etc.
While the list totals 18 distinct skills, it's important to note that not all are required to be mastered to the same degree. Some skills may only need a basic understanding, whereas others demand a higher level of expertise.
For instance, as a Health Insurance Operations Manager, he or she needs to be proficient in Budgeting, be skilled in Planning and Organizing, and be skilled in Coordination.

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