Operations Support Specialist

Sunshine State Health Plan, Inc. Washington , DC 20319

Posted 2 months ago

The Operations Support Specialist works closely with the internal Operations team, outside vendors, and consultants to help complete objectives that support the CAQH organizational goals. A successful Operations Support Specialist must be highly motivated individual who thrives in a fast-paced environment with constantly changing priorities. This person should be an excellent communicator and a patient problem solver with exceptional time management skills.

The position reports to a Senior Manager, Operations and is a full-time non-exempt role.


Resolve operational problems within the defined schedules and service level agreements.

Analyze root causes of operational malfunctions and provide resolutions.

Handle escalated issues and follow-up on outstanding issues promptly.

Engage with healthcare providers to encourage them to use CAQH solutions for submitting their information to health plans and other participating organizations. Explain the benefits of the solutions and how they work.

Provide troubleshooting assistance to providers who require help using the system.

Develop preventive measures and document issue resolution procedures.

Manage calendars and flows to ensure timely completion.

Recommend process improvements to improve operational efficiency and cost-effectiveness.

Monitor system operations and troubleshoot problems.

Assist in budget preparation and resource allocation for support services.

Install, support and maintain Policies & Procedures.

Maintain daily logs of operational issues and maintenance activities.

Track performance metrics related to outbound campaigns and generate reports to demonstrate the performance of outbound marketing initiatives.

Contribute to business meetings and report on issue status.

Develop support plan to prioritize and resolve multiple issues.

Address customer issues promptly and accurately.

Perform provider outreach.

Support quality assurance and auditing initiatives by executing test cases/audit instructions to ensure system quality and reliability.

Use critical thinking to see the big picture, determine the problem and understand fundamental parts of the problem.


  • Strong critical thinking skills.

  • Ability to drive components of large multi-functional projects.

  • Self-starter with strong initiative.

  • Ability to adapt quickly.

  • Experience/skills using Excel, PowerPoint, and Access.

  • Workflow management tool experience preferred (e.g. Salesforce, Microsoft Dynamics or another CRM).


  • 1-2 years of experience in an operations role required.

  • 1-2 years of project management experience preferred.

  • Call center and vendor management experience preferred.


  • Bachelor's degree preferred (business, healthcare administration, or technology).


Named one of Modern Healthcare's Best Places to Work in 2016, 2017, 2018 and 2019, CAQH, a non-profit alliance, is the leader in creating shared initiatives to streamline the business of healthcare. Through collaboration and innovation, CAQH accelerates the transformation of business processes, delivering value to providers, patients and health plans.

COB Smart quickly and accurately directs coordination of benefits processes.

EnrollHub reduces costly paper checks with enrollment for electronic payments and electronic remittance advice.

CAQH ProView eases the burden of provider data collection, maintenance and distribution.

DirectAssure increases the accuracy of health plan provider directories.

VeriFideTM streamlines credentialing by consolidating and standardizing primary source verification.

SanctionsTrack delivers comprehensive, multi-state information on healthcare provider licensure disciplinary actions.

CAQH CORE maximizes business efficiency and savings by developing and implementing national operating rules.

CAQH Index benchmarks progress and helps optimize operations by tracking industry adoption of electronic administrative transactions.


CAQH recognizes that its most important asset is its growing team of smart, creative, collaborative, forward-thinking and passionate professionals - and that a comprehensive employee benefits package is an important factor for them in choosing where to work. CAQH offers competitive compensation along with an extensive benefits package for all full-time employees, including medical, dental and vision coverage, tuition assistance and a 401k. Our location in downtown Washington, DC is metro-accessible, has an onsite fitness center and is centrally located to allow our team to take advantage of professional networking opportunities, cultural offerings and a thriving social scene.

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Operations Support Specialist

Sunshine State Health Plan, Inc.