Operations Unit Coordinator, Local Claims, CNY
Excellus BlueCross BlueShield - Syracuse, NY

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The Operations Unit Coordinator is viewed as a user expert in a specified operations unit. Must have iFacets knowledge. This position is responsible for coordinating the daily production of assigned unit, including but not limited to Membership & Billing, Claims, Customer Service and/or Reconciliation departments. Individuals in this position are responsible for organizing “the work” of varying scope and complexity as it relates to the unit. All incumbents will possess an in-depth understanding of the work, systems and processes as it pertains to their assigned unit. They will provide solutions and direction to staff to free their unit of inconsistencies while creating a consistent customer experience.

Essential Responsibilities/Accountabilities
All levels
• Accountable for accuracy and timeliness of own work
• Prioritizes work and provides instruction, advice and guidance to more junior staff as it relates to the assigned units’ processes, procedures, and business systems.
• Controls and monitors inventory levels of assigned department (including but not limited to Claims, Reconciliation, SLA, and Enrollment) according to established priorities and performance standards.
• Regularly handles complex issues, escalated customer questions, high maintenance or priority customers for the assigned business unit.
• Monitors and evaluates workflow to ensure timeliness and unit standards are met. Provides reporting to unit management.
• Coordinates to ensure consistent policy and procedures and customer experience across regions.
• Collaborates with junior level staff and is a positive influence within a team unit structure.
• Serves as an intermediary between staff and management to alert supervisor of potential problems.
• Assists with staff development through mentoring and troubleshooting of unit related questions. Assesses staff and unit training needs and reports this information to the supervisor.
• Provides support to the supervisor for the development and maintenance of routine reports.
• Collaborates with Operations Process or Operations Systems Experts regarding changes in processes/systems and identifies problems and recommends logical and effective solution.
• Understands validated and non-validated concepts in order to respond to questions.
• Understands performance of team activities; ability to identify problem areas of the unit, devise solutions to enhance quality of service and to prevent future problems or repeat issues.
• Facilitates adherence to unit Service Level Agreements (SLA) commitments and monthly metrics reporting
• Demonstrates role-specific competencies as it pertains to their work unit on a consistent basis
• Ensures that work is accurately and efficiently processed while providing service to customers.
• Follows-up on information for their unit.
• Conducts unit meetings and discussions where opposing points of view arise and brings them to a productive conclusion
• Follows service excellence standards and best practices across regions.
• Based on unit environment recommends needs for additional skills or training.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values and adhering to the Corporate Code of Conduct.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.
Level II
In addition to Level I responsibilities:
• Provides coverage for other Coordinators in a function unrelated to their assigned unit to ensure sufficient backup. Works with areas outside the immediate unit to resolve inventory (including but not limited to unprocessed claims, uncollected accounts and/or enrollment forms etc.) issues.
• Seeks internal or external activities to enhance capabilities.
• Competent to fill roles across work units on a consistent basis.
• Understands and is able to verify validated concepts in order to determine the most appropriate course of action for complex customer issues, complaints, claims, etc.
• Resolves complex issues that involve multiple processes or units and collaborates with others outside of the assigned functional area.
All levels
• Seasoned professional with in-depth understanding of the assigned business department’s functions, processes and systems.
• AAS degree and three years related work experience as it pertains to the assigned operations business unit. In lieu of degree seven years of experience in related area.
• Able to work on multiple issues, customer issues and unit projects simultaneously.
• Must have unit specific knowledge of business systems and Health Plan operations.
• Gains trust quickly of other parties in negotiations.
• Strong customer relations, verbal, written and interpersonal skills
• Demonstrated ability to learn
• Excellent oral communication skills
• Demonstrated ability to work independently
• Decision making skills
• Powerful customer focus
• Strong listening skills
• Self motivated, performance accountability
• Is recognized as a unit lead expert by peers.
• Ability to function in a team environment
• Experience working in a professional, corporate environment
• Diplomatic. Understands the organizational culture.
• Ability to multitask with detail retention, high level of specificity in tasks.
• Ability to manage assignments from inception to completion successfully.
• Demonstrates role-specific competencies as it pertains to their work unit on a consistent basis
Level II
In addition to Level I:
• Demonstrated broad understanding of multiple business units OR demonstrated in-depth knowledge of multiple functions, processes and/or systems within a unit.
• Must have at least one year prior experience in a leadership role.
• Highest level of expertise below management.
Physical Requirements
• Travel to other regions may be required
In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.
Equal Opportunity Employer

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