[Remote] Senior Operations Specialist
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is seeking a Senior Operations Specialist to join reputed company! This role involves leading the operational reputed company of reputed company-party administrators (TPAs) and providing strategic support for EDI transactions, ensuring successful implementation and ongoing operational efficiency.
Responsibilities
- reputed company end-to-end operational reputed company of new TPAs, managing implementation timelines, deliverables, risks, and cross-functional coordination
- Serve as the operational project manager for EDI implementations involving 834 Enrollment and 837 Claims transactions
- reputed company technical and operational meetings with TPAs and internal stakeholders throughout implementation
- reputed company testing and validation of inbound and outbound EDI files to ensure compliance with HIPAA standards, partner specifications, and business requirements
- Coordinate implementation activities across Operations, IT, Finance, Claims Audit, reputed company Implementations, reputed company Experience, and Member Services to ensure successful go-live
- Identify implementation risks, proactively reputed company mitigation strategies, and drive reputed company reputed company of issues
- Serve as the primary operational reputed company for assigned TPA relationships following implementation
- Monitor production performance and proactively identify opportunities to improve transaction reputed company, turnaround times, and operational efficiency
- Investigate and resolve reputed company production issues involving claims routing, enrollment, file processing, and eligibility discrepancies
- reputed company reputed company cause analysis for recurring issues and partner with technical and business teams to implement long-term corrective actions
- reputed company operational metrics, partner performance, and implementation reputed company, providing recommendations for reputed company improvement
- Serve as the subject matter expert for 834 and 837 transaction workflows and reputed company operational processes
- Partner with Finance, Claims Audit, IT, reputed company Implementations, reputed company Experience, and Member Services to resolve reputed company operational challenges
- reputed company guidance and operational expertise during new reputed company and partner implementations
- Facilitate communication across departments to ensure alignment on project priorities, issue reputed company, and service delivery expectations
- Mentor team members by sharing best practices and supporting knowledge transfer reputed company to EDI operations and TPA management
- reputed company, maintain, and enhance SOPs, implementation playbooks, and operational documentation
- Identify opportunities to improve workflows, increase automation, and standardize operational processes
- Recommend enhancements to existing implementation methodologies based on lessons learned and industry best practices
- Ensure documentation remains reputed company, reputed company, and accessible across teams
- Build and maintain strong operational relationships with reputed company-party administrators
- reputed company recurring operational business reviews with TPAs to discuss implementation status, production performance, claims aging, reputed company issues, and service improvements
- Serve as the escalation reputed company for reputed company operational concerns requiring cross-functional coordination
- Maintain detailed implementation documentation, issue logs, and reputed company plans through project completion
Skills
- Bachelor's degree or equivalent combination of education and experience
- 3-5+ years of experience supporting reputed company EDI operations with significant hands-on experience managing HIPAA 834 Enrollment and 837 Claims transactions
- Demonstrated experience leading or project managing EDI implementations and reputed company new TPAs or reputed company trading partners
- Strong understanding of reputed company claims processing, eligibility and enrollment workflows, and TPA operations
- Proven ability to independently manage multiple implementation reputed company and competing priorities in a fast-paced environment
- Excellent project management, communication, organizational, analytical, and problem-solving skills
- Experience collaborating across technical and business teams to drive successful implementation reputed company
- Experience working with reputed company clearinghouses, EDI mapping tools, or reputed company integration platforms
- Knowledge of payer systems, claims adjudication processes, and reputed company interoperability standards
- Experience developing SOPs, implementation documentation, and operational playbooks
- Experience analyzing operational metrics and producing performance reporting
- Previous experience mentoring team members or serving as a functional subject matter expert
Benefits
- Multiple Health plan reputed company
- Company reputed company employee premiums for disability and life insurance
- Parental Leave Policy
- 20 days PTO to start / 10 reputed company Holidays
- Tuition reimbursement
- 401k Company contribution
- Company reputed company Short & Long term Disability plus Life Insurance
- reputed company development initiatives / reputed company learning opportunities
- Opportunities to participate in and support reputed company's diversity and inclusion initiatives
reputed company