Insurance Operations Analyst

Group Health Cooperative of South Central Wisconsin. BETTER TOGETHER

The Insurance Operations Analyst is a versatile and highly analytical role within the Insurance Operations team, which includes the Enrollment, Claims, and Premium Billing departments. This position is responsible for leading and supporting a wide range of project-based initiatives that enhance operational efficiency, ensure regulatory compliance, and improve data stewardship across the organization.

Operating independently under the guidance of the Insurance Operations Manager, the Analyst serves as a key internal resource for complex tasks supporting front-line staff. These tasks may include recurring operational processes, ad hoc project requests, and cross-functional efforts that require coordination with Information Technology and other business units. They will play a pivotal role in interpreting and reconciling data from multiple systems, identifying process improvement opportunities, and ensuring that internal operations align with external requirements from regulators and business partners. While the role is primarily internally focused, it supports the organization's ability to meet external obligations through rigorous internal analysis and coordination.

A strong command of Microsoft Excel is essential, including advanced functions such as pivot tables, VLOOKUP/XLOOKUP, and conditional logic. They will also work within the Epic electronic medical records system to extract and analyze data relevant to insurance operations. While no programming is required, the role demands a high level of data literacy and problem-solving ability.

The Insurance Operations Analyst must be comfortable shifting between leadership and support roles depending on the nature of the project. They will often spearhead initiatives, drive process documentation, and collaborate with department leads to implement solutions. The role will understand, explain, and document the relationship between different areas in the Insurance Operations space, growing into a subject matter expert on internal workflows.

GHC-SCW is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. In dedication to the health and well-being of our employees, we offer a comprehensive benefits package that includes health and dental insurance, along with paid short-term disability, long-term disability, and life insurance. Additional benefits include a flexible spending account, employee assistance programs, tuition reimbursement, pet insurance, eyewear discounts, and more. Check us out by clicking on Many Talents, One Mission! The Benefits of Working at GHC-SCW.

Job Specific Minimum Qualifications

1. Bachelor's degree in Business, Public Administration, Health Administration, or a related field is required. Equivalent combination of education and extensive relevant work experience may be considered.
2. Minimum of one (1) to three (3) years of experience in healthcare, insurance operations, government programs, or a related environment performing data analysis, process improvement, and operational support is preferred.
3. Demonstrated ability to analyze and interpret complex data sets and translate findings into actionable insights for operational improvement and compliance.
4. Strong proficiency in Microsoft Excel, including advanced functions such as pivot tables, VLOOKUP/XLOOKUP, conditional formatting, and formula-based analysis.
5. Ability to create and present visualizations and reports (charts, tables, dashboards) that support decision-making and process optimization.
6. Familiarity with insurance operations workflows, including claims adjudication, coordination of benefits, enrollment, and premium billing processes.
7. Ability to learn and navigate Epic or similar electronic medical records systems and understand data flows across operational platforms.
8. Proven ability to work collaboratively with Information Technology teams to troubleshoot issues, support system enhancements, and align business needs with technical solutions.
9. Strong organizational skills with the ability to prioritize tasks, manage multiple projects, and adapt to changing priorities.
10. Excellent written and verbal communication skills, with the ability to convey complex information clearly to both technical and non-technical audiences.
11. Ability to work independently with minimal supervision while maintaining a high level of attention to detail and accountability.
12. Demonstrated ability to lead or support cross-functional initiatives, including those involving multiple departments or stakeholders.
13. Commitment to maintaining confidentiality and understanding of HIPAA and other relevant regulatory requirements.
14. Strong interpersonal skills and the ability to work effectively with diverse teams and individuals across the organization.
15. Ability to bend, reach, lift, pull, and carry up to 20 lbs regularly required.
16. Ability to speak and listen in person and on the phone required.
17. Ability to see mid, near, and far range required.

The incumbent knows and abides by all Group Health Cooperative of South Central Wisconsin (GHC-SCW) organizational and departmental policies, sets personal standards and strives for high quality work in completing assignments, performs job duties in a timely manner, and represents the organization in a positive manner. The incumbent understands our Mission, Vision and Common Values (stated below) and is committed to promote these values in behavior and attitude.

Our Mission Statement: We partner with members and the communities we serve to maximize health and well-being.

Our Vision: As a local, not-for-profit, member-owned Cooperative, we are the most trusted resource for lifelong health and well-being in the communities we serve.

Our Values:

• We are a not-for-profit Cooperative
• We are member-centered
• We are equitable and inclusive
• We are quality-driven
• We are innovative
• We are community involved

We believe:

Healthcare is a human right.

In treating all people with dignity and respect.

There is strength in diversity.

Equity celebrates our humanity.

We are better together.

Group Health Cooperative of South Central Wisconsin is proud to be an equal opportunity employer. GHC-SCW considers candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.