Sr Specialist, Process Review (Remote)

Lensa; Columbus (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 ensure compliance across operations. This role involves conducting thorough analyses, collaborating with various departments, and serving as a key resource for process documentation and audits. The ideal candidate will have a strong background in analytical roles, particularly within operations, and will leverage their problem-solving skills to drive process improvements. Join a dynamic environment where your contributions will significantly impact the organization’s operational efficiency and compliance standards.

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.
• Collaborate with process owners to create business process documentation.

Skills

Analytical Skills

Problem-Solving Skills

Communication Skills

Education

Associate's Degree

Bachelor's Degree

Job description

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 corresponding written documentation. Use analytical skills to identify variances and problem-solving skills to recommend process improvements.
• Summarize and document assessment outcomes and recommendations, ensuring clear 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 a liaison between Core Operations and internal/external 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, both written and verbal.
• 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 in managed care operations, including enrollment, encounter processes, provider and contract configuration, provider info management, claims processing, etc.

Preferred Education

Bachelor's Degree.

Preferred Experience

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

Interested Molina employees should apply through the intranet. Molina Healthcare offers competitive benefits and is an Equal Opportunity Employer. Pay Range: $77,969 - $116,835 annually.

Additional Details

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