6 hard skills or competencies (industry competencies) for Health Insurance Operations Manager
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)
Identifies the key legislation and regulations governing insurance contracts.
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Level 2 Behaviors
(Light Experience)
Records and maintains insurance policy and claims information in a database system.
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Level 3 Behaviors
(Moderate Experience)
Verifies received insurance coverage and damage reports to ensure accurate processing of claims.
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Level 4 Behaviors
(Extensive Experience)
Provides technical guidance to staff on claim investigation to ensure accurate insurance claims processing.
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Level 5 Behaviors
(Mastery)
Pursues creative initiatives that may differentiate our business and give us a competitive advantage.
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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.
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Level 2 Behaviors
(Light Experience)
Supports the execution of a legal and regulatory framework to promote strict insurance compliance.
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Level 3 Behaviors
(Moderate Experience)
Performs compliance reviews to determine possible violations and deficiencies in insurance regulations.
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Level 4 Behaviors
(Extensive Experience)
Trains teams on new laws and regulations to reduce liability risks and compliance violations.
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Level 5 Behaviors
(Mastery)
Establishes best practices in creating insurance laws and regulations to prevent frauds and malpractices.
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1 general skill or competency (Job family competency) for Health Insurance Operations Manager
Skill definition-Controlling costs, driving service excellence, and mitigating risks to gain increased value from their vendors.
Level 1 Behaviors
(General Familiarity)
Identifies and lists basic tools used for vendor operations and contract negotiations.
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Level 2 Behaviors
(Light Experience)
Suggests qualified suppliers for approved vendor list to the management.
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Level 3 Behaviors
(Moderate Experience)
Presents data and analysis results to executive management to support pricing decisions for vendor contracting.
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Level 4 Behaviors
(Extensive Experience)
Monitors vendor conformity to the organization’s operational processes and management guidelines.
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Level 5 Behaviors
(Mastery)
Establishes and institutes vendor relationship management programs to push improvement in supplier performance.
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11 soft skills or competencies (core competencies) for Health Insurance Operations Manager
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)
Explains the different purposes and uses of our organization's budgets.
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Level 2 Behaviors
(Light Experience)
Produces budget reports showing planned vs. actual variances highlighted and explained.
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Level 3 Behaviors
(Moderate Experience)
Reviews and helps approve major budget adjustments to negotiate and reconcile line variances.
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Level 4 Behaviors
(Extensive Experience)
Monitors budgeting processes to ensure adherence to our organization's financial practices and standards.
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Level 5 Behaviors
(Mastery)
Forecasts asset needs to leverage available inventory and data compilation for annual budgeting.
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Skill definition-Managing and prioritizing resources and workloads by creating well-organized plans to attain organizational goals and objectives.
Level 1 Behaviors
(General Familiarity)
Explains the importance of planning and organization in building a good working environment.
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Level 2 Behaviors
(Light Experience)
Identifies key implications of ineffective planning and organization that affects decision-making.
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Level 3 Behaviors
(Moderate Experience)
Leverages key performance indicators to measure progress completion against performance metrics.
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Level 4 Behaviors
(Extensive Experience)
Manages the planning and sequencing of activities to create well-planned schedules and achieve goals on time.
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Level 5 Behaviors
(Mastery)
Establishes standards for planning and organization processes to align efforts with business goals.
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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.