Process Expert II: COB & Medicare Compliance

Elevance Health; Tampa (FL); Hybrid; USD 95,000 - 130,000; Full time

Benefits offered by this job

Hybrid work arrangement

Medical, dental, vision benefits

401(k) + match

Job summary

Elevance Health is seeking a Process Expert II to support COB guidelines, NAIC regulations, and Medicare rules across business lines. The role emphasizes data-driven process improvements, audit-ready analyses, and cross-functional collaboration in a hybrid work environment.

The successful candidate will leverage SQL and data validation skills to optimize operations, lead projects, and ensure compliance within a high-volume managed care setting.

Qualifications

• Requires BA/BS and minimum 5 years experience in business analysis, process improvement, or project coordination in high-volume managed care operations.
• Expert in COB auditing, NAIC regulations, and Medicare Secondary Payer Rules across business lines.
• Strong analytical, data validation, and reporting skills; able to drive process improvements.

Responsibilities

• Researches workflow problems and system irregularities to identify improvements.
• Develops, explores, and executes SQL queries on COB concepts to derive insights.
• Investigates data gaps and system inconsistencies to enhance efficiency and savings.
• Develops tests and leads project plans; communicates status and outcomes.
• Supports user acceptance testing and data validation for new systems.

Skills

SQL queries

COB auditing

NAIC regulations

Medicare Secondary Payer Rules

Data validation

Process improvement

Business analysis

Project coordination

Education

BA/BS

Job description

Elevance Health is seeking a Process Expert II to support COB guidelines, NAIC regulations, and Medicare rules across business lines. The role emphasizes data-driven process improvements, audit-ready analyses, and cross-functional collaboration in a hybrid work environment.

The successful candidate will leverage SQL and data validation skills to optimize operations, lead projects, and ensure compliance within a high-volume managed care setting.