Company Statement
EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com.
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Performance Analyst, Enrollment & Billing - Remote
Summary of Job
Continuously and proactively assess and monitor enrollment and billing operations vendor performance to achieve
contractual targets daily. Frequently interface with Membership and Billing Tower Leaders to continuously identify and communicate opportunities for improvement with enrollment and billing processes. Identify areas of improvements in operational areas, provide appropriate action plans, develop and implement performance analysis programs and metrics to improve operational efficiency. Direct day-to-day Enrollment and Billing vendor operations and establish seamless cadence with line management counterparts at each vendor.
Responsibilities
- Assess and monitor performance of Operations vendors for each core process to meet contractual requirements and align with the enterprise customer experience objectives.
- Conduct reviews, transactional audits, and compliance and operational procedure reviews.
- Work with various business partners to define, design and develop analytic solutions to improve optimization and identify and mitigate risks.
- Apply timely, accurate and consistent understanding of risk across the organization to predict and gauge operational risks.
- Analyze performance data to compare intended outcomes with actual outcomes.
- Evaluate quality controls to assess effectiveness in identifying errors in systems and processes.
- Prepare reports and presentation to communicate results to Operations management.
- Maintain meticulous audit and other assessment records; compare current information to baseline historical performance and track and trend over time.
- Document special variation events that impact performance as well as corrective action(s) taken to address issue(s).
- Communicate and collaborate with other Operations management stakeholders as needed to support overall enterprise quality and customer experience objectives.
- Support Operations Tower Leads as needed to conduct/complete ad-hoc assessments and assignments.
Qualifications
- BS or BA degree
- 3 – 5+ years of relevant experience in auditing and assessment activities (Required)
- Additional experience/specialized training/certifications may be considered in lieu of educational requirement (Required)
- Process subject matter expertise and work experience for functional Operations Tower (Required)
- Excellent collaboration skills and the ability to influence management decisions (Required)
- Strong auditing skills that be applied across all types of business problems (Required)
- Strong communication skills - verbal, written, presentation, interpersonal with all types/levels of audiences (Required)
- Proficient with MS Office - Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc. (Required)
- Working knowledge of applicable systems utilized by Operations groups (Required)
Security Disclosure
If you receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.
Pay Disclosure
At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.
EEOC Statement
We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.
Sponsorship Statement
At EmblemHealth, we are committed to building a diverse and talented workforce. However, we are unable to consider applicants who require, or are likely to require, either before or after hire, visa sponsorship for work authorization in the United States, including but not limited to H-1B, F-1 (STEM OPT), TN, or any other non-immigrant status. Some extremely rare exceptions may apply based on critical business needs.