Operations Specialist

E-Verify Program

. Identify and document escalated, recurring or complex system, process and workflow problems; identify trends, recommend solutions/alternatives and work to resolve issues .

Posted 4/24/2026full-timeNorth Carolina • 🇺🇸 United StatesMid-LevelSenior💰 $41,600 - $66,561 per yearWebsite

About the role

Key responsibilities & impact

Identify and document escalated, recurring or complex system, process and workflow problems; identify trends, recommend solutions/alternatives and work to resolve issues
Serve as a subject matter expert for employees’ inquiries and internal/external audits/projects around work process, procedures, products, and policies and provide support, testing, coaching or first level escalation, and research support as needed
Provide cross functional support and departmental expertise to varied internal stakeholders
Responsible for departmental reporting, tracking and/or data analysis as needed
Perform quality reviews of inquiries to determine the accuracy of information provided and ensure employees are functioning at the expected level of service to enhance customer interaction
Communicate the results of the reviews to improve individual and overall performance and make recommendations for coaching and training as necessary
Process a variety of transactions that may include suspended claims, inquiries, adjustments, and/or correspondence
Determine benefit eligibility on suspended claims for specific products by utilizing medical records, certificate/benefit provisions, and clinical knowledge
Act as a point of contact for compliance and communicate compliance needs to management staff
Make direct high volume outreach calls to targeted members utilizing effective engagement strategies and soft sales techniques to respectfully encourage members to engage in Case Management or Disease Management services
May place outbound calls to various providers, customers or other outside contacts
Coach, educate and guide members in case management and health program participation to increase enrollment and drive positive health outcomes for our members
May include coordinating relevant mailings of educational or other company materials to members
May support clinical staff through referrals, mailbox management, work assignment and relevant documentation
May assist in the review and update of SOPs for Membership and key business partners
May handle more complex problems of eligibility and documentation with producers
May provide additional information to underwriting staff when submitting referrals for exception consideration

Requirements

What you’ll need

High school diploma or GED
3+ years of experience in related field
Experience in Behavioral Health preferred
Prior customer service experience
Ability to work independently; self-driven
Strong team player
Solid organizational skills

Benefits

Comp & perks

Medical, dental, and vision coverage along with numerous health and wellness programs
Parental leave and support plus adoption and surrogacy assistance
Career development programs and tuition reimbursement for continued education
401k match
Work-life balance, flexibility, and the autonomy to do great work

ATS Keywords

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Applicant Tracking System Keywords

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

Hard Skills & Tools

data analysisquality reviewcase managementhealth program participationcompliancetransaction processingbenefit eligibility determinationcoachingcustomer interactionSOP review

Soft Skills

communicationorganizational skillsteam playerindependent workproblem-solvingcoachingcustomer serviceengagement strategiesresearch supporttraining recommendations

Certifications

high school diplomaGED