Community Health Plan of Washington · 1 day ago
Operations Analyst
United States
Full-time
Remote
Mid Level
3+ years expCommunity Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. The Operations Analyst role is responsible for executing process improvement and quality monitoring within Claims Operations and the business processes impacted by Operations data and systems.
Health Care
Responsibilities
Responsible for State and CMS claims benefit interpretation and application, and oversight of system benefit and pricing configuration
Gather business requirements for claims benefit configuration to support system updates, enhancements and implementation of new products
Facilitate the development and execution of user acceptance scenarios and scripts for testing of system changes, implementations, and enhancements. Peer review and support system enhancements and configuration of vendor systems
Provide support for electronic data interchange (EDI) data files and CHPW web-based interfaces
Interpret, monitor, and ensure compliance with state, CMS, OIC requirements; pricing, audit performance, encounter data submissions/reporting, and vendor management
Other duties as assigned
Qualification
Required
Bachelor's degree in health care or related field or an equivalent combination of education and highly relevant experience required
Minimum three (3) years' managed care/health plan operations experience required, with proven broad knowledge and execution of quality improvement methods and tools
Minimum two (2) years' business/operations analysis experience in a related field required
Complete and successfully pass a criminal background check
Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency
Vaccination requirement (CHPW offers a process for medical or religious exemptions)
Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation
Preferred
Background in Medicaid and Medicare claims adjudication, benefits configuration, claims coding, electronic data interface, and encounter data reporting preferred
Experience in managed care/health plan operations and business/operations analysis experience in a related field
Benefits
Medical, Prescription, Dental, and Vision
Telehealth app
Flexible Spending Accounts, Health Savings Accounts
Basic Life AD&D, Short and Long-Term Disability
Voluntary Life, Critical Care, and Long-Term Care Insurance
401(k) Retirement and generous employer match effective the 1st of the month following or coinciding with the employee’s start date
Wellness programs (Employee Assistance Program and Mental Fitness app)
Financial Coaching, Identity Theft Protection
Paid Time Off (PTO) including PTO accrual starting at 17 days per year
40 hours Community Service volunteer time
10 standard holidays, 2 floating holidays
Compassion time off, jury duty
A monthly stipend to offset work-from-home expenses for roles that are 100% remote
Company
Community Health Plan of Washington
For over 30 years, Community Health Plan of Washington (CHPW) has been providing quality health care to Washington families and supporting your choices for health care.
501-1000 employees
H1B Sponsorship
Community Health Plan of Washington has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (3)
2024 (2)
2023 (1)
2022 (2)
2020 (1)
Funding
Current Stage
Late StageLeadership Team
Leanne Berge
Chief Executive Officer
Stacy Kessel, CPA
Chief Financial Officer
Recent News
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