Job Summary

The Workforce Optimization Analyst is responsible for all resource planning for internal Claims departments and external augmentation teams, including forecasting staffing needs and scheduling.  This includes implementing real-time adjustments.  The position leverages expert knowledge of inventory management and partners closely with the Claims team and leadership to ensure that Claims operations is staffed with the right people, with the right skills, at the right time to meet or exceed service level objectives.

Essential Responsibilities

• Prepare accurate forecasts and budgets for claims staff workload, including vendor augmentation teams.
• In partnership with team supervisors, coordinate all scheduling activities, including vacation bids and strategies to mitigate shrinkage (e.g., breaks, holidays, sick time, paid time off, team meetings, training, etc.).
• Analyze claims inventory volume patterns by line of business, channel, service tier, service level agreements and agent skill to ensure adequate staffing levels and effective resource allocation.
• Monitor business, resource and seasonal changes and trends and create predictive resource plans.
• Analyze and report on forecasting accuracy, comparing expected versus experienced performance results; adjust forecasting models accordingly.
• Partner with the Claims team and leadership to identify opportunities to improve resource utilization.
• Partner closely with Claims leadership and trainers to align forecasting models and staffing allocation with Claim Examiner skill levels; predict and help address and resolve skill gaps.
• Actively work with supervisors and team leads to ensure claims are processed in order of receipt.
• Actively manage and co-create workforce management tools, such as productivity reports, inventory reports, inventory burndown plans, to ensure all regulatory and contractual Claims service level agreements and goals are achieved.
• Provide recommendations to leadership to plan for upcoming impacts to volume.
• Facilitate weekly inventory huddles with the Claims team and leadership to provide visuals of the progress against goals, direct activities to problem solve for any issues, and answer questions.
• Provide feedback and recommendations to supervisors on adjustments to configuration regarding roles and skill mapping, claims queue designs and prioritization.

Organizational Responsibilities

• Perform work in alignment with the organization’s mission, vision and values.
• Support the organization’s commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
• Strive to meet annual business goals in support the organization’s strategic goals.
• Adhere to the organization’s policies, procedures and other relevant compliance needs.
• Perform other duties as needed.

Knowledge, Skills and Abilities Required

• Ability to create advanced forecasting, capacity planning and scheduling for health care claims departments with the intent to achieve customer experience and service level objectives in a cost-effective manner
• Strong skills using claims management technology from industry leading providers such as TriZetto QNXT Enterprise Core Administration Systems, or Facets.
• Advanced skills in Microsoft Excel, specifically related to forecasting, scenario modeling and statistics
• Strong skills in Microsoft Word and PowerPoint
• Ability to think analytically, apply analytical techniques, provide in-depth analysis, and interpret information
• Problem-solving skills including the ability to see trends and patterns in data as well as develop and implement an improved course of action
• Ability to proactively identify ways to improve claim processing speed, cost and quality

• Excellent oral and written communication skills
• Ability to work under pressure in a complex and rapidly changing environment
• Ability to work effectively in an environment with diverse individuals and groups
• Ability to comply with and support organizational policies, procedures and guidelines
• Ability to proactively work to build and improve team operations
• Ability to participate fully and constructively in organizational meetings and contribute to departmental decisions
• Ability to participate in and occasionally manage projects with minimal guidance

Education and/or Experience

Required:

• Minimum 3 years’ experience using systems and data to support decision making; experience should include at least 1 year experience utilizing inventory management technology for scenario modeling, such as QNXT Workflow and use of Microsoft Excel

Preferred:

• 3 years of forecasting, capacity planning and scheduling for healthcare claims processing
• Knowledge of Health Claims processing
• Experience configuring Health Claims Systems for Benefits, Contracts for Government Programs (Medicaid and Medicare) and Commercial Plans

Working Conditions

• Environment:  This position’s primary responsibilities typically take place in the following environment(s) (check all that apply on a regular basis):

? Inside/office            ? Clinics/health facilities         ? Member homes

? Other_________________________________________

• Travel:  This position may include occasional required or optional travel outside of the workplace, in which the employee’s personal vehicle, local transit, or other means of transportation may be used.
• Equipment:  General office equipment
• Hazards:  n/a

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment

Veterans are strongly encouraged to apply. 

Equal opportunity employer.  This company considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.