Sr Specialist, Process Review (Remote)

Lensa; Augusta (GA); Remote; USD 77,000 - 117,000; Full time

Job summary

An established industry player is seeking a skilled professional to enhance business processes and manage change effectively. In this role, you will be responsible for analyzing operations, ensuring compliance, and facilitating communication across departments. Your expertise will help streamline processes and improve overall efficiency. This full-time position offers a competitive salary and the opportunity to contribute to a dynamic team focused on operational excellence in the healthcare sector. If you have a passion for analytics and process improvement, this is the perfect opportunity for you.

Qualifications

• 4+ years of analytical experience in operations or process-focused environments.
• Experience in managed care operations and compliance.

Responsibilities

• Provide business process redesign and change management for operations.
• Conduct interviews and assess compliance with internal guidelines.

Skills

Analytical Skills

Problem-Solving Skills

Communication Skills

Business Process Documentation

Education

Associate's Degree

Bachelor's Degree

Job description

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Lensa is the leading career site for job seekers at every stage of their career. Our client, Molina Healthcare, is seeking professionals. Apply via Lensa today!

Job Description

Job Summary

Responsible for providing business process redesign, communication, and change management for operations. Backend operationalization of policies, standardization of system set-up, and serving as a resource for all departments and health plans company-wide.

Knowledge/Skills/Abilities

• Conduct interviews with staff and management to assess internal business processes within a department or function to ensure compliance with organizational Policies and Procedures, Standard Operating Procedures, and other internal guidelines.
• Review, research, analyze, and evaluate information to assess compliance between a process or function and the written documentation. Use analytical skills to identify variances. Use problem-solving skills and business knowledge to recommend process improvements.
• Summarize and document assessment outcomes and recommendations. Communicate findings effectively to process owners and management.
• Collaborate with process owners to maintain/create business process documentation and workflows related to Core Operations functions.
• Serve as liaison between Core Operations and internal/external auditors for all formal audits that are not compliance-related.
• Coordinate, facilitate, and document audit walkthroughs.
• Research, gather, or generate requested documentation. Provide timely, accurate responses in written and verbal forms.
• Respond to clarifying questions from auditors and work with other functional areas as needed.

Job Qualifications

Required Education

Associate's Degree or two years of equivalent experience

Required Experience

• Four years of proven analytical experience within an operations or process-focused environment. Additional experience for Corporate Operations includes:
• Experience within managed care operations.
• Knowledge of managed care enrollment, encounter processes, provider and contract configuration, provider information management, claims processing, and related functions.

Preferred Education

Bachelor's Degree

Preferred Experience

• Six years of proven analytical experience within an operations or process-focused environment.
• Previous audit and/or oversight experience.

To all current Molina employees: If interested, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $77,969 - $116,835 / ANNUAL

• Actual compensation may vary based on location, experience, education, and skill level.

Additional Details

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Information Technology
• Industries: IT Services and IT Consulting