Operational Excellence Analyst III

CareSource

Operational Excellence Analyst III overseeing operations regulatory requirements and SOC-1 controls. Leading HEDIS initiatives with mentoring of analysts in a hybrid environment.

Posted 6/16/2026full-timeDayton • Ohio • 🇺🇸 United StatesMid-LevelSenior💰 $72,200 - $115,500 per yearWebsite

About the role

Key responsibilities & impact

Take a leading role in the oversight and monitoring of Operations regulatory requirements, and Service Organization Control-1 (SOC-1) controls
Take a leading role in the oversight and monitoring of Operations specific HEDIS initiatives and accreditation requirements
Interpret regulatory requirements to identify gaps and drive improvements
Demonstrate leadership ability, including mentoring Operational Excellence Analysts to identify and perform oversight and monitoring of Claims, Provider Appeals, Provider Services (claims processing only), Provider Life Cycle and Enrollment processes
Generate comprehensive, clear, concise, and in-depth reporting and analysis and provide recommendations based on findings
Conduct monthly quality reviews with the Operations Management team
Work under limited supervision with considerable latitude for initiative and independent judgement
Perform a variety of reviews or evaluations that are usually without precedent and requires the use of advanced techniques in gathering and evaluating pertinent data
Work cross-functionally with the Operations Management team to identify risks, controls, and process gaps and drive improvements
Identify and lead process-improvement initiatives
Track financial savings related to process improvements
Track financial cost related to outages and process issues
Perform any other job duties as requested

Requirements

What you’ll need

Bachelor of Science/Arts, or equivalent years of relevant work experience is required
Minimum of five (5) years of health care operations experience in insurance, managed care, or related industry is required
Intermediate proficiency level with Microsoft Office suite, including Microsoft Project, Visio and Minitab is preferred
Advanced troubleshooting and problem-solving capabilities
Data analysis and process mapping preferred
Overall knowledge and understanding of Operations-related systems, technical specifications and processes is preferred
Solid understanding of claims processing
Ability to conduct oversight, monitoring, and auditing of operational areas
Ability to understand and translate SOC-1, accreditation and regulatory requirements
Ability to document and maintain business and system requirements including process flows
Ability to analyze processes and produce recommendations for improvements
Excellent oral, written, and interpersonal communication skills
Ability to manage time effectively
Effective relationship management skills
Effective organization and prioritization skills
Effective facilitation and interpersonal skills
Strong critical thinking and problem resolution skills
Six Sigma Green or Black Belt is preferred

Benefits

Comp & perks

bonuses tied to company and individual performance
substantial and comprehensive total rewards package

ATS Keywords

✓ Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

data analysisprocess mappingclaims processingtroubleshootingproblem-solvingoversightmonitoringauditingprocess improvementfinancial tracking

Soft Skills

leadershipmentoringcommunicationtime managementrelationship managementorganizationprioritizationfacilitationcritical thinkingproblem resolution

Certifications

Six Sigma Green BeltSix Sigma Black Belt