Health Plan Operations Specialist


: $56,745.00 - $94,660.00 /year *

Employment Type

: Full-Time


: Non-Executive Management

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Kforce has a client in search of a Health Plan Operations Specialist in Austin, TX. Overview: The Health Plan Service Operations Specialist I delivers member support through a variety of approaches and procedures; resulting in high quality of care though the life cycle of the member's time with the company. The incumbent provides guidance and support, educates members on their benefits and care options, and coordinates with Providers, Clinics and Facilities to ensure care is delivered as effectively as possible to produce the best outcomes. The Health Plan Service Operations Specialist I will join the company in one of 5 major work groups within the department, as described below, and will be expected to continually expand their knowledge by cross-training within all other areas of the department and become an invaluable resource within the company. Principal Duties and Responsibilities: The Health Plan Operations Specialist I will be assigned to one of five key areas within the Health Plan Service area. Training and proficiency is to be demonstrated in this area before being trained in other key areas. Tasks for each key area include: Member/Provider Services Programs:
  • Answer inbound calls to provide assistance to members, providers, and/or healthcare personnel regarding coordination of care, enrollment, benefits, or claims within defined business guidelines
  • Facilitate cross functional communication to all groups within Health Plan Service Operations
  • Confirm requests are fully resolved and all questions are answered, ensuring member satisfaction
  • Adhere to Medicare guidelines, if applicable; Treatment Surveillance Programs
  • Monitor real-time member treatments to identify, investigate and determine intervention opportunities; Maintain oversight of members until they return to routine care
  • Identify members discharged from the hospital to ensure timely follow up and continued support

Job Requirements:


  • High School diploma/GED required; Work toward and advanced degree preferred
  • 0 - 1 years of related experience
  • Previous successful problem-solving experience
  • Must have clear and persuasive patient communication skills
  • Excellent critical thinking skills
  • Excellent verbal and written communication skills
  • Successful short task project management
  • Familiar with Microsoft Office applications, and computer user interfaces
  • Must be organized and detail oriented with a strong bias for follow-up and problem resolution
  • Proven ability to be a team player
  • Prior call center experience a plus
  • Health insurance experience a plus
  • Prior medical office experience a plus
Kforce is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, or disability status.

* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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