Health Plan Issue Resolution Consultant - 9 Months, may Convert (69038

HEALTH PLAN ISSUE RESOLUTION CONSULTANT

CONTRACT: 9 months (W2); possible conversion; preference given to those individuals eligible to convert to FTE

LOCATION: Portland, OR 97232

JOB NUMBER: 69038

DEPARTMENT: Membership Accounting/Group Billing

- This role will be primarily focused on day-to-day issue coordination and triage. Issues can be systematic or a process problem that is causing discrepancies that impact the members. Example: Members are getting charged the wrong co-pay, and the root cause can be a configuration problem, and then identifying this as well as a Remedy to the problem. Facilitating the steps to rectify the issue.
- There is a strong facilitative problem solving component - The Consultant will take a lead role in helping teams solve day-to-day issues/problems and partner closely with the Issue Manager to identify and escalate trending problems.

JOB DESCRIPTION:

- The HPOS Issue Resolution Consultant works with staff and managers from all parts of the organization to identify health plan related issues and drive timely, well-scoped issue resolution, fix root causes so issues do not resurface, and improve organizational learning and member satisfaction.
- The Consultant will facilitate capturing, triaging, analysing, documenting and resolving, health plan related issues and their solutions that have the potential to negatively impact members/customers and internal teams.
- The Consultant will work closely with Issue Manager to audit and report on trending problems.
- The Consultant will develop a strong understanding for end-to-end processes and will facilitate broader learning and identification for areas of process improvement while collaborating with regional and shared service partners/stakeholders.

TOP DAILY RESPONSIBILITIES:

- Work with key stakeholders to facilitate the capture, triage and documentation of health plan issues, lead development of scope and root cause identification. Develop appropriate messaging, communication-ready synopses for escalation where appropriate. Capture key decisions and remediation action steps and assigned owners for follow-up and reference. Assist stakeholders in obtaining latest information, serve as point of contact for existing issues. (50%)
- Monitor issues to ensure remediation is completed and documented within affected systems and processes. (15%)
- Conduct issue audits for completeness, root cause validation and reporting for trending issues. (10%)
- Work with stakeholders to implement process improvements and system enhancements to improve workflow efficiency and performance. Assistance may include, but is not limited to gathering business and/or customer requirements, business case development, data collection, testing, and communication/change management activities with stakeholders. Functional and system enhancements include: integration with interfacing incident tracking, testing, and audit systems (BMC Remedy, Pega Systems, Microsoft Sharepoint, Cognos); development of an Issue resolution knowledge base; development and refinement of standard templates, forms, queries and tools; enhanced reports and dashboards; optimized system handoffs, process performance between issue management and other production systems. (20%)
- Other duties as assigned. (5%)

MINIMUM REQUIRED EDUCATION:

- Bachelor's degree OR 4 years of experience in directly related field

MINIMUM WORK EXPERIENCE:

- 3 years' experience in health care, business administration, training, education, consulting, etc
- 2 years' experience in customer service/stakeholder relationship management
- 3 years' investigative or analytical problem solving experience

TOP REQUIRED SKILLS:

- Excellent writing and communication skills, ability to communicate fluently with technical and non-technical, staff, managers, and executives
- Demonstrated process improvement and change management skills
- Demonstrated understanding and practice of project management and/or facilitative leadership
- Strong inherent desire to solve challenging and complex problems

KEY CHARACTERISTICS OF THE IDEAL CANDIDATE (IN NO PARTICULAR ORDER):

- Must love puzzles/problem solving, possess inherently logical, organized approach to diagnosis, and the ability to think "three-dimensionally" - that is, the ability to deconstruct/unpack a process or problem into smaller logical parts
- Creative, ability to solution non-linearly, out of the box - possess good judgment/sense of balance between "not recreating the wheel" and knowing when to disregard "the way it's always been done"
- Fast, inferential learner with strong "desire to know"
- Collaborative, facilitative, ability to partner; strong teaching and customer service aptitude
- Basic SQL/Database experience and/or technical propensity to learn
- Combination: Rigorous attention to detail paired with appreciation for larger system/scope; detail-oriented systems-thinker
- Self-driven initiative, persistence to make things right
- Strong ability to synthesize and simplify communication of complicated concepts

PREFERRED EXPERIENCE (NOT REQUIRED BUT NICE TO HAVE):

- Six Sigma Green Belt/Black Belt certification (or completed coursework) preferred
- Experience working with Issue Resolution/Issue Management/IT Service Management software
- Structured Query Language (SQL) or similar database reporting experience, or demonstrated technical aptitude/propensity to learn
- PMP Certification
- Experience working in health insurance operations