Lead Core Operations

Job Summary

Providing lead support for core operations activities, the full-time Lead Core Operations will manage escalations, coordinate workflow, and serve as a subject matter expert in claims processing and provider services.

Key responsibilities

• Manage escalations within the department, ensuring accountability and effective communication
• Perform daily troubleshooting for enrollment, disenrollment, and claims support functions
• Coordinate workflow and staffing, assigning and monitoring staff work to meet quality standards

Required qualifications

• At least 4 years of experience in health care operations, claims, or provider services
• Knowledge of Medicare, Medicaid, and Marketplace plans
• Experience in a Medicaid or large claims processing environment
• Strong organizational and time-management skills
• Proficiency in Microsoft Office suite, including Excel