Health Plan Operations Analysts and Health Plan Operations Team Leads

Lumenos, a leader in consumer-driven health care, is seeking Health Plan Operations Analysts and Health Plan Operations Team Leads to work at its corporate headquarters in Alexandria, VA. These positions support the daily operations for consumer driven health plan (CDHP) technology solutions operated by Lumenos for WellPoint regions.  They are responsible for meeting operational service level agreements with financial impact on the organization.

 Responsibilities:Work with WellPoint operations staff to support day-to-day operation of consumer-driven product technology solutions, including customer service, medical and pharmacy claims processing, eligibility processing, group setup/configuration and reporting to meet organizational and client objectives.  In this capacity, this position interfaces with all levels of WellPoint operations management and with third party vendor staff.  Operational support responsibilities include:Monitoring routine file exchanges and data loads (batch and realtime), taking corrective action when processes fail.  This requires in-depth knowledge of processes and sound judgment in determining corrective action.  Suggest process improvements based on experience with processes.Participating in regularly scheduled meetings to discuss issues and determine resolution.Investigating issues reported internally or externally by WellPoint operations staff or third party vendors.  Suggest solutions for resolving issues.Conducting periodic data reconciliations between Lumenos and WellPoint or vendor systems using MS Access and custom queries.  Investigate and report root cause of discrepancies.Configuring new products and groups for CDHP groups based on client specifications.Understand WellPoint SLAs related to service level performance guarantees and the system and operational impact to those guarantees.  Responsible for metric tracking, issue identification, resolution and root cause analysis to proactively exceed service level guarantees.

3.  Ensure that all processes and standard operating procedures are adequately documented, kept up to date and stored appropriately for reference by Health Plan Operations staff.

4.  Participate in software QA/UAT activities related to the implementation of new requirements.

5.  In addition to providing hands on support and participating in all activities listed above, Team Lead position will also direct and prioritize day-to-day work of team members, escalate issues to Health Plan Operations Manager and apprise manager of status of all activities.

 Skills and Qualifications:Bachelor?s or associate?s degree required, preferably in a technical field.  Equivalent work experience may be substituted.Prior operations, business analysis or software QA experience strongly desired.Technical aptitude and the proven ability to learn and understand new software applications required.Working knowledge of relational databases including experience with SQL required.Working knowledge of MS Access strongly desired.Must be detail-oriented, organized and able to work independently to manage multiple tasks simultaneously in a fast-paced environment.Excellent analytical and problem solving skills. Health care industry experience strongly desired but not required.Must be willing to provide remote weekend and on call support on a rotating basis.  Second shift support may also be required on a rotating basis.

Lumenos is a member of the WellPoint family of companies.  Lumenos is an Equal Opportunity Employer