Sr Specialist, Process Review (Remote)

Lensa; Cleveland (OH); Remote; USD 77,000 - 117,000; Full time

Job summary

A leading career site is seeking a professional for a mid-senior level role focused on business process redesign and compliance within operations. The position involves conducting assessments, collaborating with stakeholders, and ensuring adherence to policies across health plans. Candidates should possess strong analytical skills and relevant experience in managed care operations.

Qualifications

• Four years of proven analytical experience in operations or process-focused environments.
• Experience in managed care operations such as enrollment or claims processing.
• Preferred six years of analytical experience with prior audit experience.

Responsibilities

• Conduct interviews to assess internal business processes.
• Collaborate with process owners to maintain business process documentation.
• Serve as liaison between Core Operations and auditors.

Skills

Analytical skills

Problem-solving skills

Communication skills

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, Procedures, Standard Operating Procedures, and other guidelines.
• Review, research, analyze, and evaluate information to assess compliance between processes and documentation. Use analytical skills to identify variances and problem-solving skills for process improvement.
• Summarize and document assessment outcomes and recommendations, ensuring effective communication to process owners and management.
• Collaborate with process owners to maintain and create business process documentation and workflows related to Core Operations functions.
• Serve as liaison between Core Operations and auditors for all formal 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, including experience in managed care operations such as enrollment, encounter processing, provider management, claims processing, etc.

Preferred Education

• Bachelor's Degree

Preferred Experience

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

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

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