Sr Specialist, Process Review (Remote)

Lensa; City of Rochester (NY); Remote; USD 60,000 - 100,000; Full time

Job summary

An established industry player is seeking a skilled professional to enhance operational efficiency through business process redesign and change management. This role involves collaborating with various departments to ensure compliance with organizational policies, conducting audits, and analyzing processes for improvements. The ideal candidate will possess strong analytical skills and a background in managed care operations. Join a forward-thinking company that values your insights and contributions, offering a dynamic work environment where your expertise will drive meaningful change.

Qualifications

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

Responsibilities

• Provide business process redesign and change management for operations.
• Collaborate with process owners to document workflows and maintain compliance.

Skills

Analytical Skills

Process Improvement

Communication

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. This includes 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, ensuring compliance with organizational Policies and Procedures, Standard Operating Procedures, and other internal guidelines.
• Review, research, analyze, and evaluate information to assess compliance between processes and documentation. Use analytical skills to identify variances and recommend process improvements.
• Summarize and document assessment outcomes and communicate findings effectively to process owners and management.
• Collaborate with process owners to maintain or create business process documentation and workflows related to Core Operations functions.
• Serve as liaison between Core Operations and internal/external auditors for audits not related to compliance.
• Coordinate, facilitate, and document audit walkthroughs.
• Research, collect, or generate requested documentation and provide timely responses.
• 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.
• Experience within managed care operations, including knowledge of enrollment, encounter processes, provider and contract configuration, claims processing, and related functions.

Preferred Education

Bachelor's Degree.

Preferred Experience

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

Note: Current Molina employees interested in this position should apply through the intranet. Molina Healthcare offers competitive benefits and is an Equal Opportunity Employer (EOE) M/F/D/V.