Your Future is our Future

At Lumeriswe believe that our greatest achievements are made possible by the talent and commitment of our team members. Thats why we are actively seeking talented and collaborative individuals who are passionate about making a difference in the healthcare industry. Join us today as we strive to create a system of care that every doctor wants for their own family and become part of a community that values its people and empowers you to make an impact.

Position:

Position Summary:

Job Description:

Primary Responsibilities

• Research and resolve complex issues and inquiries from vendors clients and internal stakeholders.
• Audit vendor performance including quality accuracy and other contractual service levels. Present findings and address deficiencies.
• Collaborate within Lumeris and with vendors and clients to drive timely communication develop or improve processes and create or approve knowledge articles training materials and other knowledge resources.
• Identify trends and develop recommendations to address issues and improve processes and practices to elevate the member and provider experience.
• Represent Customer Service as a member of the Operations Implementation Team (OIT).
• Compile and present data reports and other information to illustrate performance results and action plans related to performance gaps.
• Participate in audits assist with corrective action plans and drive other process performance and compliance activities.
• Collaborate with cross-functional teams to develop process maps and identify improvement opportunities.
• Identify and document requirements for new products solutions markets and other initiatives and participate in user acceptance testing.
• Other work and duties as assigned.

Qualifications

• Bachelors degree or commensurate experience with the demonstrated ability to perform the responsibilities outlined in the Job Description.
• Minimum of three years of health plan operations experience or commensurate experience with the demonstrated ability to perform the responsibilities outlined in the Job Description.
• Knowledge of healthcare regulations Lumeris MA benefits and CMS guidelines and policies.
• Strong commitment to Service Excellence and driving a BEST-IN-CLASS customer experience that results in a Five Star CMS rating.
• Strong PC skills including intermediate abilities using Microsoft Word Excel PowerPoint and Smartsheet.
• Experience with Wrike or the ability to learn how to utilize Wrike.
• Experience with Genesys and Pure Insights or the ability to learn how to utilize these workforce management tools.
• Proficiency developing new and documenting current process maps and proposing improvement opportunities.
• Excellent written and verbal communication skills including the ability to professionally interact with associates at all levels.
• Demonstrated ability to be proactive flexible enthusiastic resourceful and detail oriented.
• Must be self-motivated and a self-starter and able to deliver at a high-level with limited direction and oversight.

Preferred:

• Lean Six Sigma or related experience

Working Conditions

• While performing the duties of this job the employee works in normal office working conditions.

Pay Transparency:

Factors that may be used to determine your actual pay rate include your specific skills experience qualifications location and comparison to other employees already in this addition to the base salary certain roles may qualify for a performance-based incentive and/or equity with eligibility depending on the position. These rewards are based on a combination of company performance and individual achievements.

The hiring range for this position is:

Benefits of working at Lumeris

• Medical Vision and Dental Plans

• Tax-Advantage Savings Accounts (FSA & HSA)

• Life Insurance and Disability Insurance

• Paid Time Off (PTO Sick Time Paid Leave Volunteer & Wellness Days)

• Employee Assistance Program

• 401k with company match

• Employee Resource Groups

• Employee Discount Program

• Learning and Development Opportunities

• And much more...

Be part of a team that is changing healthcare!

Member Facing Position:

Location:

Time Type:

Lumeris and its partners are committed to protecting our high-risk members & prospects when conducting business in-person. All personnel who interact with at-risk members or prospects are required to have completed at a minimum the initial series of an approved COVID-19 vaccine. If this role has been identified as member-facing proof of vaccination will be required as a condition of employment.

Disclaimer:

• The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities duties and skills required. The physical activities demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individual with disabilities to perform the essential job duties and responsibilities.

Lumeris is an EEO/AA employer M/F/V/D.