Medical Mutual Job - 43255560 | CareerArc
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Company: Medical Mutual
Location: Brooklyn, OH
Career Level: Associate
Industries: Banking, Insurance, Financial Services

Description

The Operations Specialist - Stop/Loss position allows you the flexibility to work at home as long as you reside within a 50-mile radius of the Brooklyn, OH Medical Mutual office.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.6 million Ohioans through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans.

 

Medical Mutual' s status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us and help our members achieve their best possible health and quality of life.

 

Coordinates workflow in assigned unit(s) to include audit, systems, processes, operations and policies. Analyzes workflow systems and provides recommendations to management for process improvements. Maintains control of the daily operational functions assigned to the unit.     

Responsibilities

  • Provides analytical and technical expertise to assist staff and/or directly respond to escalated and/or more complex issues.
  • Monitors, plans, distributes workflow/daily production and maintains required level of quality within assigned units.  Analyzes current workflow and provides recommendations for improvement to enhance the overall efficiency.
  • Prepares and monitors reports used by management to review production and quality standards.  Reviews and responds to quality audits.  Participates in troubleshooting to support quality initiatives.  Advises staff on areas of improvement.
  • Assists manager with staff development through performance coaching and on-the-job training.  Provides feedback to the manager regarding the staff's progress.
  • Evaluates and reviews impact of changes (systems, procedural, contractual, etc.) and presents findings/issues/recommendations to management for appropriate resolution and assists with implementation.
  • Attends meetings at the request of management.
  • Performs other duties as assigned.


Qualifications

Qualifications

Education and Experience:

  • Bachelors' Degree in Business or Healthcare Administration or related field preferred, but will consider collective experience, training and education.
  • 5 years progressive health insurance claims and/or customer service operations experience which includes significant exposure to assigned department's subject matter.

 

 

Professional Certification(s):

  • Certified Self-Funded Specialist (CSFS) preferred.

 

 

Technical Skills and Knowledge:

  • Strong knowledge of policies, procedures and systems in assigned area.
  • Intermediate to advanced Microsoft Office and MS Excel skills.
  • Knowledge of all lines of business, benefits, operational policies/procedures, client contracts, applicable insurance regulations, and systems.

 

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:

  • Top Workplace in Northeast Ohio. Year after year we've received this recognition!
  • On-site wellness center at most locations. Enjoy personal trainers, towel service, locker room, weight room, elliptical machines, and a variety of classes!
  • On-site cafeteria serving hot breakfast and lunch, at most locations. Choices ranging from salad bar, made to order, hot and cold sandwiches, or a variety of entrees cooked fresh daily. Convenience store at most locations
  • Employee discount program. Discounts at many places in and around town, just for being a Medical Mutual team member
  • Business Casual attire

Excellent Benefits and Compensation:

  • Competitive compensation plans
  • Employee bonus program
  • 401(k) with company match and an additional company contribution
  • Excellent medical, dental, vision, and disability insurance

An Investment in You:

  • Career development programs and classes
  • Mentoring and coaching to help you advance
  • Education reimbursement up to $5K per year

About Medical Mutual:

We strive to create peace of mind. Our customers can trust us to do things right and to help them get value from their health plan. We're the largest health insurer in Ohio and for over 85 years, we've been serving our members and the Ohio communities where they live and work. Medical Mutual is a Top Place to Work in Northeast Ohio with exceptional career opportunities that offer challenge, growth and a great work/life balance. We want talented, innovative, and driven people to help us continue to be the best health insurance choice of Ohioans and help make Ohio the best it can be! Our headquarter building is located in the heart of downtown Cleveland and we have multiple offices throughout the state. Join us at one near you!

 

At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.


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