About us:

Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

Brief Summary Of Purpose: 

The Business Consultant I position provides support to the operational activities of the above with the objective of meeting the needs of both internal/external customers, regulatory requirements and creating efficiencies to current workflows.  They will be involved in many cross functional projects based on the goals and objectives of the organization.  This opportunity requires the ability to ramp up and integrate quickly, apply rigorous approach and use of time-tested project management techniques to deliver on enterprise projects.

• Support operational projects in collaboration w/business operational subject matter experts
• Obtain a solid understanding of operational knowledge (Enrollment, Billing, Claims, Customer Service and Provider)
• Having technical skills, such as, but not limited to, Excel, QNXT table structure, MS Access
• Optimization of QNXT systems in collaboration w/the Configuration team
• Interface & Extract business requirements and testing in collaboration w/operational business subject matter experts
• Providing representation at the applicable committee meetings
• Development and maintenance of test plans across operations to support various applications and projects
• Detailed testing, remediation, implementation to production and post-deploy measures
• Ongoing exploration of ongoing process improvement opportunities

Primary Job Responsbilities:

• Participate in QNXT upgrade testing for customer service, enrollment and billing provider, claims and I/E units and reporting
• Collaborate and communicate with other operational areas to improve operational performance and customer satisfaction
• Ensure up-to-date documentation of policies and procedures
• Adherence to comprehensive training materials and sessions provided to staff with to support achievement of performance objectives
• Adherence to the use of supporting systems/applications and technical skills and implementation of process improvement opportunities ongoing
• Allocate resource time to strategize and test functionality available in QNXT to maximize the core systems.
• Serve in a consultative capacity to operations with recommendations for enhancements.
• Partner with IT on the relationship management for C
• Establish and maintain effective communication and cooperation with internal and external business partners
• Regular review of business processes to determine potential efficiencies based on creative thinking, new system functionality or configuration opportunities
• Identify opportunities for improving system configuration; determine root cause, implement actions to realize those opportunities
• Work in conjunction with Operations Support Services to assist with Improving operational efficiencies for operations department

Education: 

Bachelor’s degree in business or equivalent business experience

Experience:

• 3+ years in an operations environment
• Experience in core system implementations
• Proficient in MS Office Suite (Word, Excel, Access, Power Point)
• Ability to run basic SQL queries
• Experience in data integrity analysis
• Strong operational knowledge of commercial/regulatory health insurance industry including various lines of business
• Comprehensive understanding of process re-engineering
• Demonstrated customer focus
• Effective communication & presentation skills
• Effective team player
• Ability to adapt to a rapidly changing business environment
• Strong focus on quality & performance results
• Strong analytical & quantitative skills
• Short and long-term planning skills
• Excellent problem  solving skills

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.