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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in process improvement and operational efficiency within healthcare, particularly in Dual Eligible Special Needs Plans (D-SNP) and compliance with CMS and Medicaid regulations. Proven ability to analyze workflows, develop business requirements, and lead cross-functional initiatives to enhance service levels and quality metrics.
Highest-signal resume keywords
Process ImprovementD-SNP ExperienceCMS Regulations KnowledgeAnalytical SkillsStakeholder Influence
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Process MappingRoot Cause AnalysisContinuous Improvement MethodologiesOperational Workflow AnalysisKPI MonitoringBusiness Requirements DevelopmentData AnalysisAutomation ImplementationChange ManagementQuality Metrics Improvement
Soft Skills
Problem-SolvingWritten CommunicationVerbal CommunicationFacilitationInfluencing Without Authority
Tools & Technologies
LucidVisio
Industry Keywords
Medicare AdvantageGovernment Healthcare ProgramsEnrollmentEligibilityClaimsCare ManagementProvider OperationsMember Services
About the role
Key responsibilities & impact- Lead end-to-end process improvement initiatives across D-SNP operations
- Analyze operational workflows, identify root causes, and recommend sustainable solutions
- Partner with business stakeholders, IT, compliance, claims, enrollment, customer service, and clinical teams
- Develop business requirements, process maps, and future-state operational designs
- Monitor and improve KPIs, service levels, quality metrics, and compliance outcomes
- Drive automation and modernization efforts to reduce manual work and operational risk
- Facilitate cross-functional meetings, decision-making, and change management activities
- Support regulatory readiness and adherence to CMS, state Medicaid, and Medicare requirements
- Present findings, recommendations, and executive summaries to leadership
- Research best business practices and establish benchmark data
- Collect and analyze process data to recommend improved business practices and procedures
- Determine how new information technologies can support business process re-engineering
Requirements
What you’ll need- Experience supporting Dual Eligible Special Needs Plans (D-SNP), Medicare Advantage, Medicaid, or government healthcare programs
- Knowledge of CMS regulations and state Medicaid requirements
- 3-5+ years of process improvement, operations, healthcare, or managed care experience
- Strong analytical and problem-solving skills
- Strong written and verbal communication skills, including executive presentations
- Experience using process mapping and documentation tools (Lucid, Visio)
- Familiarity with enrollment, eligibility, claims, care management, provider operations, or member services
- Experience with root cause analysis and continuous improvement methodologies
- Proven ability to influence stakeholders without direct authority
- Experience leading complex, enterprise-wide initiatives and process redesign efforts
Benefits
Comp & perks- Bonus incentive plan based on company and/or individual performance
- Medical, dental and vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company and personal holidays
- Paid parental and caregiver leave
- Short-term and long-term disability
- Life insurance
- Work-from-home arrangement
- Dedicated workspace and internet requirements for home employees