Senior Leader overseeing Platform Operations at Wells Fargo, managing critical operational services and driving transformation. Responsible for enhancing service quality and efficiency across multiple functions.
About the role
- Operational Excellence Analyst overseeing compliance and HEDIS initiatives in healthcare operations. Monitoring claims, provider services, and conducting quality reviews collaboration with the management team.
Responsibilities
- Oversight and monitoring of Operations regulatory requirements
- Oversight and monitoring of Operations specific HEDIS initiatives and accreditation requirements
- Identify and perform oversight and monitoring of Claims, Provider Appeals, Provider Services (claims processing only), Provider Life Cycle and/or Enrollment processes
- Generate monthly reporting, analyze and recommendations based on findings
- Conduct monthly quality reviews with the Operations Management team
- Work cross-functionally with the Operations Management team to identify process gaps and drive improvements
- Perform any other job duties as requested
Requirements
- Associates of Science/Arts degree in Management Information Systems (MIS) or related field or equivalent year of relevant work experience
- Minimum of one (1) year of experience working in a business environment
- Two to five (2 to 5) years of experience in Healthcare Operations is preferred
- Two to five (2 to 5) years of experience translating business requirements into technical specifications is preferred
- Intermediate proficiency level with Microsoft Office Suite, including Project and Visio
- Advanced troubleshooting and problem-solving capabilities
- Data analysis and process mapping
- Overall knowledge and understanding of Operations-related systems, technical specifications and processes
- Basic understanding of claims processing
- Ability to conduct oversight, monitoring and auditing of operational areas
- Ability to understand accreditation and regulatory requirements
- Ability to document and maintain business and system requirements including process flows
- Ability to analyze processes and produce recommendations for improvements
- Excellent written and verbal communication skills
- Effective listening and critical thinking skills
- Strong interpersonal skills and high level of professionalism
- Effective problem solving skills with attention to detail
- Ability to work independently and within a team
- Ability to develop, prioritize and accomplish goals
Benefits
- Bonus tied to company and individual performance
- Comprehensive total rewards package
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