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%
$111,380
TOTAL 50%
$123,630
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)
Explains the policy conditions of various insurance contracts and products.
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Level 2 Behaviors
(Light Experience)
Provides prompt responses to clients’ insurance-related questions and concerns.
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Level 3 Behaviors
(Moderate Experience)
Reviews and analyzes claim applications to determine coverage eligibility and rates.
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Level 4 Behaviors
(Extensive Experience)
Monitors market trends in insurance services to deliver improved business impacts.
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Level 5 Behaviors
(Mastery)
Establishes and enforces standards for handling claims to maximize insurance workflow efficiency.
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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)
Discusses the importance of insurance regulations in protecting clients' financial security and assets.
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Level 2 Behaviors
(Light Experience)
Gathers and interprets policy contracts to understand insurance legal and regulatory standards.
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Level 3 Behaviors
(Moderate Experience)
Maintains financial and market regulation to validate insurance's accounting methods and procedures.
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Level 4 Behaviors
(Extensive Experience)
Sets guidelines to promote fairness and transparency in financial markets in providing insurance products.
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Level 5 Behaviors
(Mastery)
Develops compliance and risk management standards to manage overall insurance legal and regulatory environment.
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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)
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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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)
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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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)
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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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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