Operations Analyst

Hours:

• 8-5 CT M-F
• Weekend/Holiday on call coverage.
• No OT requirements

Purpose of Team:

• This is a second level production support position to assist users and/or assist with application issues/outages via a ticketing system.
• Lots of screen sharing with users, teams messaging with clinical and non-clinical staff documenting member data (authorizations, appeals, assessments, care plans, member outreach, etc.) to troubleshoot application issues.
• Team also collaborates/works closely with our IT partners for issues requiring IT intervention.
• Culture is collaborative
• Fast paced environment, triaging and responding to escalations/global within SLA's.

What makes the role unique: These are clinical applications therefore there are clinical processes behind the actions they are taking and are programmed into the applications.

Responsibilities:

• Interfaces with internal associates and external resources, including Subcontractors and Government entities, to gather information and implement solutions. Participates in projects to identify and document business requirements, implement new technology, research and resolve business issues, and plan and develop systems implementation tactics, including project and test plan input.
• Role is focused on supporting TruCare Cloud and TruCare Classic platforms for end users.
• Incident management - provide timely and accurate user support/troubleshooting as well as management of escalations within enterprise SLA's (Service Level Agreements).
• Gathers, evaluates, interprets, and analyzes data and business processes, or develops test scenarios to evaluate system defects.
• Presents information, recommendations and alternatives to facilitate management understanding of results and impact.
• Produces reports or file extracts for data analysis.
• Evaluates Enrollment department policies and procedures and recommends changes to improve the overall productivity and quality of department systems.
• Identifies opportunities to improve system processes and recommend changes to streamline operations and/or automate manual processes.
• At times, may assume responsibility for data integrity among various internal groups and/or between internal and external sources.
• Participates in projects that contribute to achievement of department objectives.
• Projects will be completed on-time, within budget, and according to established objectives and documented requirements.
• Participates in developing project plans, test plans, implementation strategies, and post implementation plans.
• Provides business function support for system upgrades and Government-mandated change orders.
• Prepares status reports and/or issue resolution to internal associates and/or external resources.
• Participates in developing and reviewing business system requirements and scope and design documents.
• Troubleshoots user-reported system defects and educates users on issues that are not true-system defects.
• Analyzes true defects and follows up with applicable subcontractor to resolve.
• Performs other duties as assigned.
• Complies with all policies and standards.

Day to Day:

• Manage new application issue tickets via Request Central.
• Follow up on previous tickets received previous days.
• Monitor for escalations. 2nd level Production support of application issues for Trucare Classic (Zyter product) and Trucare Cloud (Centne Product).
• Incident management - timely and accurate user support/troubleshooting as well as management of escalations within enterprise SLA's (Service Level Agreements).
• Gathers, evaluates, interprets, and analyzes data and business processes, or develops test scenarios to evaluate system defects.
• Presents information, recommendations and alternatives to facilitate management understanding of results and impact.
• troubleshoots user-reported system defects and educates users on issues that are not true-system defects.
• Analyzes true defects and follows up with applicable subcontractor to resolve.
• * Role requires qualified candidates to be available for on call / weekend work due to TruCare system deployments. **

Performance Expectations/Metrics: Monthly ticket metrics monitored. Expectation is for team to close 70-100 tickets/month

TOP REQUIREMENTS:

1

Troubleshooting technical issues

2

Problem-solving skills

3

Communication skills, written and verbal

• Required: Bachelors or equivalent work experience
• Years of experience required: 2 years
• Two years health plan or health insurance operations experience, including participating on project teams.
• Experience in researching and analyzing data for the purpose of process improvement is preferred.
• Experience in Enrollment, billing and/or claims processing preferred.
• Ideal candidates will have experience with TruCare Cloud and Classic as well as utilization management or care management knowledge.
• Previous experience with Trucare Classic (Zyter platform) or Trucare Cloud (Centene platform) preferred.
• Additional qualities to look for: Self-starter, organized, good at prioritizing based on urgency.

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Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad Digital, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad Digital offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.


It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.