Offer summary

Qualifications:

High school diploma or equivalent required; Associate’s degree preferred., Minimum of two years experience in a managed care or healthcare environment., Experience in developing policies and procedures is required., Intermediate proficiency in Microsoft Office Suite and excellent writing and communication skills..

Key responsabilities:

Coordinate, develop, and maintain the Service Operations knowledge repository.

Communicate new and revised policies and procedures to Service Operations staff.

Collaborate with other departments to develop and review cross-functional policies and procedures.

Lead the Service Operations Policy and Procedure Committee and maintain a solid understanding of accreditation and regulatory requirements.

Job description

Job Summary:

The Customer Care Knowledge Specialist is responsible for the coordination, development and maintenance of the Service Operations knowledge repository that houses policies, procedures, process flows and job aids for consumer care representatives to utilize in response to member and provider call inquiries for Medicaid, Medicare, and future lines of business.

Essential Functions:

Responsible for the coordination, development and maintenance of the Service Operations knowledge repository that houses policies, procedures, process flows and job aids for consumer care representatives to utilize in response to member and provide call inquiries for Medicaid, Medicare, and future lines of business
Responsible for communication to Service Operations staff on new and revised policies, procedures, job aids, and process flow information within the knowledge repository as changes occur
Identify, develop and design information for the knowledge repository for all teams in Service Operations
Collaborate with other departments to develop and/or review cross-functional policies, procedures, process flows, and job aids
Collaborate with Service Operation’s teams on a regular basis to identify new or changing processes
Attend departmental and project meetings to identify additional policies
Point of contact for the department e-Manuals
Develop and maintain Standard Operating Procedures for Service Operations
Maintain a solid understanding of all policies and procedures to maintain Subject Matter Expert (SME) status
Have a solid understanding of accreditation and regulatory requirements such as NCQA, URAC, OAC Rules, etc.
Design and maintain a master list of policies, procedures and owners
Lead the Service Operations Policy and Procedure Committee
Communicate new policy and procedures to the appropriate Service Operations teams
Communicate Standard Operating Procedure and organizational updates to Service Operations teams
Job shadow with the teams in Service Operations to identify additional needed policies and procedures, training opportunities and/or additional e-Manual processes
Perform any other job duties as requested

Education and Experience:

High school Diploma or equivalent is required
Associate’s Degree is preferred
Minimum of two (2) years of experience in a managed care or healthcare environment is required
Minimum of two (2) years of experience in developing policies and procedures is required

Competencies, Knowledge and Skills:

Intermediate proficiency level with Microsoft Word, Excel, Power Point and Share Point
Visio experience is preferred
Instructional design preferred
Excellent writing skills
Excellent communication skills
General claims knowledge
Ability to work independently and within a team environment
Attention to detail and documentation
Leading discussions
Self-motivated, self-directed
Understanding of managed care members, providers, claims and appeals processes
Proper grammar usage
Decision making and problem solving skills

Licensure and Certification:

None

Working Conditions:

General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

$46,500.00 - $74,500.00

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Hourly

Organization Level Competencies