Location: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Schedule: This position will work an 8-hour first shift, Monday through Friday. Additional hours, including weekends or holidays, may be required based on operational needs.

Carelon Global Solutions (CGS), a fully owned subsidiary of Elevance Health, is a healthcare solutions company that is simplifying complex operational processes to improve the health of the healthcare system.

The Operations Expert is responsible for providing technical direction, guidance and resources to operations, claims, customer service, or membership associates on a day-to-day basis.

How You Will Make an Impact

Primary duties may include, but are not limited to:

• Serves as a first line resource for operation associates for workflow and technical related processes.

• Provides operational training; assists associates by answering day-to-day technical questions and encourages a teamwork environment.

• Monitors inventory to ensure workflow remains uninterrupted.

• Handles complex case research and resolution.

• Reviews, interprets and maintains records of service level, quality, accuracy, and productivity.

• Reviews department policy and procedure manuals for accuracy.

• Works with training department to ensure procedures and policies are accurate and complete.

• Expected to have the ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers.

• Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment.

• Possess strong verbal and written communication skills, both with virtual and in-person interactions.  

• Attentive to details, critical thinker, and a problem-solver;  demonstrates empathy and persistence to resolve caller issues completely.

• Comfortable and proficient with digital tools and platforms to enhance productivity and minimize manual efforts.

• Will have a structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary.

• Performs other duties as assigned.

Minimum Requirements:

• Requires HS diploma or equivalent and a minimum of 5 years related experience which includes a minimum of 3 years of directly related experience and expertise with company relevant automated processing systems; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences: 

• Previous leadership experience preferred.

• Knowledge of state mandates and regulations related to newborns is preferred.

For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills