Process Expert II

Elevance Health; Indianapolis (IN); Hybrid; USD 85,000 - 105,000; Full time

Benefits offered by this job

Medical

Dental

Vision

401(k) + match

Stock purchase plan

Job summary

Elevance Health in Indianapolis negotiates hybrid work and supports a Process Expert II role focused on COB guidelines with NAIC and Medicare Secondary Payer Rules. This position contributes to a single operations department and emphasizes data insights, validation, and process improvement across multiple lines.

The role requires 5+ years in business analysis or related fields and a BA/BS degree, with collaboration 1–2 days per week in the office to foster teamwork and balance.

Qualifications

• BA/BS degree and minimum 5 years in business analysis, process improvement, or project coordination in a high-volume managed care operation.
• Experience with claims, customer service, enrollment and billing is preferred.

Responsibilities

• Researches operations workflow problems and system irregularities.
• Develops, explores, and executes SQL queries on COB concepts.
• Conducts investigation outreach to validate primacy and eligibility updates.
• Develops tests and presents process improvement solutions for new systems.
• Leads project plans and communicates status for new accounts and operational improvements.

Skills

SQL queries

Data analysis

Problem solving

Data validation

Auditing

Analytical thinking

Education

BA/BS degree

Job description

Process Expert II

Location: Hybrid1: This role requires associates be in the office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance.This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.Alternate locations may be considered.

*Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The Process Expert II supports a single operations department by participating in project and process work. This employee will be an expert in COB guidelines, including NAIC regulations and Medicare Secondary Payer Rules, applicable across all business lines.

How you will make an impact:

• Researches operations workflow problems and system irregularities
• Proficient in developing, exploring, and executing SQL queries on complex COB concepts, utilizing extensive experience with data insights and auditing techniques.
• Skilled in conducting thorough investigation research and engaging in necessary outreach (e.g., OHI, CMS, employers, ESRs) to ensure accurate validation of primacy and eligibility updates.
• Develops tests, presents process improvement solutions for new systems.
• New accounts and other operational improvements; develops and leads project plans and communicates project status.

Minimum Requirements:

• Requires a BA/BS and minimum of 5 years experience in business analysis, process improvement, project coordination in a high-volume managed care operation (claims, customer service, enrollment and billing); or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

• 5-7 years of comprehensive experience in COB auditing, covering both CB and GB concepts.
• Expert in COB guidelines, including NAIC regulations and Medicare Secondary Payer Rules, applicable across all business lines.
• Adept at researching and analyzing data gaps and system inconsistencies to enhance efficiency and capture savings opportunities through prevention and recoveries.
• Capable of identifying innovative ideas, approaches, and processes to optimize savings and operational efficiency.
• Consistently uphold high standards of quality assurance.
• Strong analytical and problem-solving abilities.
• Support user acceptance testing and contribute to data validation and reporting analysis.
• Proficient in data validation and reporting analysis.
• Ability to analyze workflows, processes, supporting systems and procedures and identifying improvements strongly preferred.

For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

Benefits and Compensation

• merit increases
• paid holidays
• Paid Time Off
• incentive bonus programs (unless covered by a collective bargaining agreement)
• medical
• dental
• vision
• short and long term disability benefits
• 401(k) +match
• stock purchase plan
• life insurance
• w wellness programs
• financial education resources
• to name a few.