Sr Specialist, Process Review (Remote)

Lensa; Bellevue (NE); Remote; USD 77,000 - 117,000; Full time

Job summary

A leading career site seeks a professional for a mid-senior level role focused on business process redesign and compliance management within Molina Healthcare. The position involves conducting assessments, collaborating with process owners, and ensuring adherence to organizational policies. Candidates should have analytical experience, preferably in managed care operations, and hold an Associate's or Bachelor's degree.

Qualifications

• Four years of analytical experience in operations or process-focused environments.
• Experience in managed care operations including enrollment and claims processing.
• Preferred six years of analytical experience and previous audit experience.

Responsibilities

• Conduct interviews to assess internal business processes for compliance.
• Analyze information to recommend process improvements.
• Serve as liaison for audits and maintain business process documentation.

Skills

Problem-solving

Analytical

Communication

Education

Associate's Degree

Bachelor's Degree

Job description

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Job Description

Job Summary

Responsible for providing business process redesign, communication, and change management for operations. Backend operationalization of policies, standardization of system setup, 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, Procedures, and SOPs.
• Review, analyze, and evaluate information to assess compliance and variances, using problem-solving skills and business knowledge to recommend process improvements.
• Summarize and document assessment outcomes and communicate them effectively to process owners and management.
• Collaborate with process owners to maintain or create business process documentation and workflows related to Core Operations.
• Serve as liaison between Core Operations and auditors for all formal audits, including coordinating walkthroughs and providing documentation.
• Research, collect, and generate requested documentation; respond to audit inquiries promptly and accurately.

Job Qualifications

Required Education

• Associate's Degree or two years of equivalent experience.

Required Experience

• Four years of analytical experience within an operations or process-focused environment.
• Additional experience in managed care operations, including enrollment, encounter processes, provider and contract configuration, claims processing, etc.

Preferred Education

• Bachelor's Degree.

Preferred Experience

• Six years of analytical experience in operations or process-focused environments.
• Previous audit or oversight experience.

To all current Molina employees: Apply through the intranet job listing if interested.

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

Pay Range: $77,969 - $116,835 / annually. Actual compensation may vary based on location, experience, education, and skills.

Additional Details

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