Operations Specialist

This is a fully remote position, open to applicants in Alabama, +24 more states.

📋 Description

• Deliver cross-functional and cross-team assistance for operational and healthcare activities that support Medicare Advantage, ACA populations, and additional lines of business.

• Direct members to primary care providers and inform them about available health benefits.

• Aid members in navigating their available benefits.

• Conduct outreach via outbound calls to providers, members, vendors, and other external contacts.

• Employ effective engagement techniques to motivate members to use available benefits and adopt healthy behaviors.

• Report engagement outcomes to leadership and team members.

• Ensure member confidentiality in compliance with HIPAA regulations.

• Mentor, educate, and assist members in participating in health programs and preventive care.

• Support team members through referrals, mailbox management, task assignments, and documentation.

• Act as a subject matter expert on work processes, procedures, products, and policies.

• Provide support, first-level escalation, and research assistance.

• Help review and update existing processes and procedures while creating new ones.

• Offer cross-functional support and departmental expertise to internal stakeholders.

• Maintain reports and conduct tracking and data analysis.

• Complete other tasks as assigned by leadership.

⛳️ Requirements

• High school diploma or GED is required.

• A minimum of 3 years of experience in a related field.

• Experience in operational healthcare systems is highly preferred.

• Familiarity with Facets for navigating member records, eligibility, benefits, and healthcare-related information is highly preferred.

• Proficiency in Genesys for call management, queue monitoring, outbound and inbound call activities, wrap-up documentation, and performance metrics is highly preferred.

• Experience with Salesforce for documenting member interactions, managing cases, tracking outreach activities, and maintaining accurate records is highly preferred.

• Ability to navigate member-facing healthcare tools and resources on Blue Connect is highly preferred.

• Strong working knowledge of Microsoft Excel, including data entry, filtering, sorting, reporting, spreadsheets, and basic data analysis is highly preferred.

• Authorization to work in the United States is required.

🏝️ Benefits

• Opportunity to work at the forefront of healthcare delivery with a team committed to community engagement.

• Work-life balance, flexibility, and the autonomy to excel in your role.

• Comprehensive medical, dental, and vision coverage.

• Various health and wellness initiatives.

• Parental leave and support.

• Assistance for adoption and surrogacy.

• Career development opportunities.

• Tuition reimbursement for ongoing education.

• 401k match along with an annual company contribution.

• Annual incentive bonus.

• Paid Time Off (PTO).

• Competitive health benefits and wellness programs.