Core Operations Manager

Position Overview

Scope Of Role & Responsibilities

• Track and advise on performance related to Core systems and vendors, including claims processing, provider setup, benefit configuration, and AP workflows.
• Manage and support business initiatives related to Core systems in accordance with corporate budgetary objectives.
• Ensure initiatives and any problem resolutions related to Core systems stay on track using platforms like Jira and ServiceNow.
• Review SLA performance and escalate concerns to leadership or vendor management teams.
• Direct and conduct communication between business units and Core system vendors on shared objectives and alignment.
• Participate and advise in new business and operational initiatives and provide guidance on current and future system capabilities.
• Collaborate with Claims Operations, Utilization Management, and Network Management to obtain and understand use cases for systems configuration methodologies.
• Identify operational inefficiencies and present improvement opportunities to the appropriate leaders.
• Support teams by clarifying system capabilities and constraints.
• Maintain visibility into system edits and collaborate with internal teams to advise on needed adjustments.

Required Education, Training & Professional Experience

• Must have a bachelor’s degree in one of the following: Information Systems/MIS, Computer Science or Software Engineering, Health Information Management, or Business Administration (Operations, IT, or Healthcare focus).
• Must have at least 5-7 years’ experience in healthcare systems, specifically with a background in healthcare payer systems such as claims processing and benefit configuration, provider data management, and systems testing/migration.
• Project Management and Staff Supervision a plus.

Licenses & Certifications

• Required: None

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Written/Oral Communication