Skills & Competencies for Health Insurance Operations Manager

Health Insurance Operations Manager job profile

Book a Demo and Receive a Sample Job Profile

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
BOOK A DEMO

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 processes and rate standards for calculating the amount for insurance claims.
See 4 More Skill Behaviors
Level 2 Behaviors
(Light Experience)
Gathers clients' financial information for the preparation of insurance contracts.
See 4 More Skill Behaviors
Level 3 Behaviors
(Moderate Experience)
Performs thorough investigation and analysis of insurance claims to prevent fraudulent activities.
See 4 More Skill Behaviors
Level 4 Behaviors
(Extensive Experience)
Leads the digitization and automation of insurance-related services to drive business transformation.
See 4 More Skill Behaviors
Level 5 Behaviors
(Mastery)
Develops loss control practices to reduce financial exposure and risks in insurance operations.
See 4 More Skill Behaviors
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)
Explains the application of insurance regulatory laws to avoid civil penalties and license suspension.
See 4 More Skill Behaviors
Level 2 Behaviors
(Light Experience)
Supports the execution of a legal and regulatory framework to promote strict insurance compliance.
See 4 More Skill Behaviors
Level 3 Behaviors
(Moderate Experience)
Performs compliance reviews to determine possible violations and deficiencies in insurance regulations.
See 4 More Skill Behaviors
Level 4 Behaviors
(Extensive Experience)
Trains teams on new laws and regulations to reduce liability risks and compliance violations.
See 4 More Skill Behaviors
Level 5 Behaviors
(Mastery)
Establishes best practices in creating insurance laws and regulations to prevent frauds and malpractices.
See 4 More Skill Behaviors
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)
Names the processes involved in vendor management, such as risk mitigation and cost control.
See 4 More Skill Behaviors
Level 2 Behaviors
(Light Experience)
Uses vendor and contract management tools in generating reports for internal use.
See 4 More Skill Behaviors
Level 3 Behaviors
(Moderate Experience)
Utilizes vendor management tools to manage costs, track quality, and measure the performance of third-party vendors.
See 4 More Skill Behaviors
Level 4 Behaviors
(Extensive Experience)
Oversees vendor portfolio to control costs, drive service excellence, and mitigate risk.
See 4 More Skill Behaviors
Level 5 Behaviors
(Mastery)
Leads the implementation of security regulatory requirements to drive vendor risk-related processes and programs.
See 4 More Skill Behaviors
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)
Lists the elements and the steps on how to conduct budgeting.
See 4 More Skill Behaviors
Level 2 Behaviors
(Light Experience)
Supplies supporting information and justification for major line items.
See 4 More Skill Behaviors
Level 3 Behaviors
(Moderate Experience)
Utilizes software tools and applications to forecast our annual budget accurately.
See 4 More Skill Behaviors
Level 4 Behaviors
(Extensive Experience)
Recommends alternative budgeting strategies for resolving budgeting issues in our workplace.
See 4 More Skill Behaviors
Level 5 Behaviors
(Mastery)
Introduces technologies, policies, and programs for more effective budget management.
See 4 More Skill Behaviors
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)
Lists commonly used tools in workplace planning and organization.
See 4 More Skill Behaviors
Level 2 Behaviors
(Light Experience)
Works with specific tools in prioritizing and allocating resources to ensure task accuracy.
See 4 More Skill Behaviors
Level 3 Behaviors
(Moderate Experience)
Prepares schedules to plan, organize, and complete priorities promptly.
See 4 More Skill Behaviors
Level 4 Behaviors
(Extensive Experience)
Sets short- and long-term objectives to organize team workload and improve efficiency.
See 4 More Skill Behaviors
Level 5 Behaviors
(Mastery)
Leads the development of new techniques and strategies to drive effective planning and organization.
See 4 More Skill Behaviors
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.

It's Easy to Get Started

Get the precision you need to assess, hire, and develop top talent with skills and competencies – see how with a personalized demo.