Job Description

Wellcove, CHCS Services is a company positioned for growth and excellence. It may not be an exciting time in the marketplace, so we aim to shake things up. We are looking at acquiring more companies and we have already begun to place a larger investment in technologies and tools for our associates and our customers.

  Our story

We’ve been in business for over 30 years. We are a global company with delivery centers in the USA and INDIA. CHCS is an award-winning insurance third-party administrator (TPA) of senior health products. We are in the business of providing state-of-the-art administrative support services and customized care solutions to manage policies and claims. CHCS Supports some of the largest senior market insurance companies in the world. Processing hundreds of thousands of claims every year and our vast network of experienced registered nurses and healthcare professionals provide personalized care management services to policyholders.

  The Future

Within the next 5 years we are seeking to become THE leader in the TPA services marketplace! To achieve this goal, we know we’ll need to build an even stronger team. We are ready to invest in the company and in you.

Investment in technologies: new call center technology is Five9s, and continually refresh of systems.

At CHCS Services, we are committed to providing innovative healthcare solutions while fostering a supportive and inclusive work environment for our associates. We can succeed together as a team by investing in our associates’ well-being and professional development.

Job Summary

The Operation Analytics Sr. Manager role develops reports for broad consumption, analyzes metrics, and reports data to the COO and high-level management encompassing market analytics, internal performance metrics, monthly status reports required by the LTCIs and other client reporting, including the accuracy of LTCIs’ monthly invoice. This role is responsible for providing a comprehensive assessment and overall evaluation of reporting deliverables and empowering the operations teams to make informed actions.

As a visual communications and data translation expert, Sr. Manager will use dashboards comprised of visualizations, charts, and tables of information to produce reports across business lines to indicate areas of improvement and successful strategies employed.

This role serves as a subject matter expert on contextual interpretation of information for the business and consults with operations to improve processes and streamline data interpretation communications across the organization.

The Operations Analytics Sr. Manager leads data system efforts for adoption and management and serves as a consultant and assistant developer on system design where process improvement needs or desired and/or required. In addition, the Operations Analytics Sr. Manager leads data analysts who also develop reports and compile periodic reporting and monitor for anomalies, as well as provide quality assurance and control for data integrity. The data analysts assist in addressing business needs through data review and communication of their resulting analysis in condensed visual representations and ad hoc reporting as requested.

  Supervisory Responsibilities:

 Oversees Analytics functions across the enterprise.

• Works with other department leaders to deliver reports & analytics.
• Responsible for Analytics

Duties/Responsibilities:

 Key metrics and reports addressed by the team include, but are not limited to, the following:

• Assessor Network
• Providers Summary & Territory Comparisons
• Potential Fraud, Waste, and Abuse based on Geofence data.
• Time Away from Home – Travel, Distance, Locations
• Activities and Instrumental Activities of Daily Living
• Caregiver relationships to policyholder
• GPS Anomalies – Accuracy, Disparate Signals
• Interacts with LTCIs to provide critical information regarding identified FWA.
• Care Management (Assessments) Dashboard
• Work closely with leadership to develop meaningful reports.
• Assignment of New Requests
• Volume by Status
• Volume by Agent/Reviewer
• Identify areas of improvement in the workflow and develop tools to streamline and make processes more efficient.
• Client Operations / Portfolio Operations Reporting (per Service Line)
• Referrals/Assessment Requests Volume by Status
• Service Level Agreements
• Status Summaries – Enrollment, Pipeline, Holds, Invoices
• Conversion Rates
• Customer Service Representative Call Analysis
• Call Volume & Wait Times
• Agent Activity & Performance
• Electronic Visit Verification Dashboard & Claims Review
• Volume by Status & Status Summaries
• QA/QC – NIGO, ACS, Holds, Stale, Past Due
• Monthly Service Line Billing – Referrals & Ongoing
• Other Duties as assigned.
  • Assessment Network. Identify where our policyholders reside to provide the Network Development team information on what market to prioritize and contract nurse assessors.
  • Verification Services Analysis (EVV and Facility)
    • Evaluate the number of claimants that haven’t been referred to enroll in the EVV and Facility programs. Missed revenue opportunities.
    • Agency / Registry Analytics – Conduct an analysis and report on the HHC agencies/registries that won’t enroll in CHCS’ EVV program. Team to be assembled and begin to reach out to the agencies/registries to work with them to develop a direct connection to start receiving their invoices electronically.
    • Fraud Analysis – Today’s GeoRisk reports are very time consuming for carriers to review. Continue to enhance our GeoRisk report and analytics to provide carriers with meaningful, user-friendly reports. By continuing to develop our ability to identify potential FWA, we are creating an opportunity to offer another value-add service to upsell to our carriers.

Development of the role: expanding as we grow.

Market analytics.

Required Skills/Abilities:

 Excellent analytical and organizational skills.

• Proficient in database and accounting computer application systems, including but not limited to:
  • PowerBi: where all CHCS’ plethora of reports are generated and has enhanced the reports to accurately report our stats and information.
  • Expert in Microsoft Office Programs
• Excellent written and verbal communication skills.
• Project management
• Critical Thinking
• Basic Programming
• Collaboration
• Leadership & Team Building
• Conflict Resolution
• Comfortable in Complex and Ambiguous situations

  Education and Experience:

 Bachelor’s degree in computer science or related field, or 5 years of work-related experience

• Minimum 5 years of experience in project management, driving execution within a rapidly changing environment.

  Preferred :

• Experience in healthcare
• Experience working with global teams.

  Standard Company Requirements:

• Collaborative team spirit.
• Accountable and able to work remotely and independently.
• Able to pass background screening and drug tests pre and post- hire.
• Verification of high school, GED, or college diploma upon request.
• Timely responses from three professional references. 

• Able to provide a dedicated remote work location free from background noises, interruptions, and desk clutter.
• Able to provide an ongoing reliable internet connection and access to a smartphone.

  Physical Requirements:

 Sit, read, write, speak, use computer keyboard.

• Prolonged periods sitting at a desk and working on a computer.
• Flexibility with work schedule to meet needs.
• Ability to travel.
• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• While performing the duties of this job, the associate is frequently required to sit; use hands, fingers, handle, or feel; and talk or hear. The employee is occasionally required to stand; walk; reach with hands and arms; climb or balance; and stoop, kneel, crouch, or crawl. The associate must occasionally lift and/or move up to 20 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, and ability to adjust focus. The associate must be able to present and speak simultaneously in meetings. 

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