Key Responsibilities
- Oversee daily operations across departments including Claims, Appeals, Network, and Compliance.
- Identify and implement process improvements to enhance operational efficiency and member experience.
- Monitor performance metrics and prepare reports for leadership review.
- Coordinate cross-functional initiatives to support strategic goals.
- Ensure compliance with CMS, AAAHC, and state regulatory requirements.
- Support transitions of care and continuity planning for high-risk members.
- Participate in Quality Improvement and Compliance Committee meetings.
- Maintain confidentiality and uphold ethical standards in all operational activities.
Qualifications
- Bachelor’s degree in healthcare administration, business, or related field (required).
- Minimum 3 years of experience in health plan operations or managed care.
- Strong analytical, communication, and organizational skills.
- Experience with operational platforms and electronic health records.
- Ability to work independently and collaboratively in a fast-paced environment.
Preferred Attributes
- Prior experience in Medicare Advantage or Special Needs Plans (SNPs).
- Knowledge of ProCare Advantage policies and workflows.
- Commitment to member-centric, trauma-informed care.
Diversity, Equity, and Inclusion are at the heart of Cantex. We are committed to a culture that respects our differences and values the contributions of all people.
We are an Equal opportunity employer; We offer an excellent benefit plan to include 401K with match, CEU reimbursement, vacation, sick, holidays, medical, dental, and supplemental insurance Plans as well as a Highly competitive compensation package.
Please visit cantexcc.com for more information on this location.
