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Guide all operational workflows and recommending and implementing areas for change, streamlining, workflow enhancements
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Define process improvement challenges, measure current process performance, analyze root causes, and develop targeted process improvement opportunities with business partners
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Work closely with cross-functional leaders to develop initiatives, including project planning, critical analyses, key resource requirements and recommendations
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Identify projects that will contribute to realizing benefits and achieving outcomes
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Ensure that the work of the project, including the scope of each project, covers the necessary aspects required to deliver the products or services that will lead to operational benefits
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Present recommendations and initiative progress, both written and verbal, to key stakeholders
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Review operational reports on a weekly and monthly basis to identify issues, areas where inefficiencies exist, and research and ultimately recommends optimization.
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Manage claims reports, claims turnaround time, member service calls, paid claims reports, etc.
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Work with the IT department, solutions architect, and vendors on the system project list
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Periodically review staffing needs
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Develop and manage an operational dashboard for teams to few significant daily statistics
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Provide a bridge for smooth communication between departments while demonstrating credibility, trust, and support
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Maintain HIPPA compliance, documents and handle confidential information with discretion, trust, and integrity
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Maintain discretion and confidentiality in relationships with all board, members, staff, and leadership as needed
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Assist employees, service representatives, members, groups, vendors and teams with appropriate forms, projects, and processes
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Establish and maintain effective relationships with staff members and gain their trust and respect
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Communicate with internal, external groups, and members through systems and regulations with precision and care, especially with confidential information
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Research, prioritize, and follow up on incoming issues and concerns
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Make great timely decisions based on training; experience, and good judgment
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Maximize and find resources (people, materials, networks, relationships, support, etc.) to use, provide solutions and support, overcome challenges, and achieve goals
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Create strong morale, let others be responsible for their work, share wins and successes