Specialist

Will this position be required to work onsite for any reason at any time? Yes

Engagement Description –

Under general supervision is responsible for assisting and supporting management in the execution, evaluation, recommendation, establishment, implementation and of production workflows, work processes for systems, reporting and new products/programs to improve customer service levels and overall quality.

Top 3 Required Skills/Experience –

• Handle escalated servicing issues by way of CMS' Complaints Tracking Module.
• Ability to work with external parties directly, such as providers and members, to resolve issues/problems and effectively communicate findings.
• Work cross departmentally to address enrollment, claims, benefit, eligibility, and billing matters.
  
  

Required Skills/Experience – The rest of the required skills/experience. Include:

• Maintain confidentiality of all information processed.
• Assist and support in the planning, coordinating, developing, and implementing of approved projects which are Divisional and/or Corporate in scope to enhance the overall efficiency of operational procedures, methods, controls, and performance.
• Analyze, process and/or expedite operational transactions; this may include timely resolution of problems.
• Participate in systems testing, develop procedures/controls and provide recommendations for the ongoing improvement of the updated process.
• Provide leadership team with status of projects; issue, communicate and recommend policy decisions to achieve project objectives.
• Utilize and maintain available corporate production and reporting systems; produce routine and non-routine reports, presentations, letters communications and graphics.
• Assist personnel (both internal and external) by answering questions, supplying information and training.
• Develop and maintain an effective working relationship with customers or partners
  
  

Preferred Skills/Experience – Optional but preferred skills/experience. Include:

• Excellent analytical, organizational, planning, and follow-up skills.
• Ability to work collaboratively in a team environment, including remotely,
• Excellent verbal and written skills, including expertise in writing for digital and social media and video,
• Ability to exercise independent judgment, meet deadlines and deliver on projects while working under limited supervision.
• Ability to comprehend complex company documents, procedures, and policies, and distill these into easy-to-understand language that supports corporate strategy.
• Ability to speak effectively before external and internal groups.
• Proficient in current industry standard PC applications and systems including Microsoft Office.
• Ability to work in a team setting and independently, and under tight deadlines.
• Ability to build trust and relationships with internal and external customers.
• Ability to maintain confidentiality.
• Ability to work with a variety of variables where limited standardization exists.
• Resourceful problem solver with ability to formulate and execute plans efficiently and effectively.
  
  

Education/Certifications – Include:

• High School Graduate or GED equivalent required. Three (3) to five (5) years of experience with benefits and procedures as related to assigned department.