Sr Specialist, Process Review (Remote)

Lensa; Detroit (MI); Remote; USD 77,000 - 117,000; Full time

Job summary

An established industry player is looking for a skilled professional to enhance their operational processes. This role focuses on business process redesign, ensuring compliance, and serving as a key resource across departments. With responsibilities ranging from conducting audits to collaborating with process owners, you'll play a vital role in driving effective change. If you have a strong analytical background and a passion for improving operational efficiency, this opportunity is perfect for you. Join a company that values your expertise and offers a competitive compensation package.

Qualifications

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

Responsibilities

• Provide business process redesign and change management for operations.
• Serve as a liaison for audits and maintain 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 documentation. Use analytical skills to identify variances and problem-solving skills to recommend process improvements.
• Summarize and document assessment outcomes and recommendations, ensuring effective communication (written and verbal) 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 and 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, accurate responses both written and verbal.
• Respond to clarifying questions from internal and external auditors, working 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:
• Analytical 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 current Molina employees: Please apply through the intranet job listing if interested.

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

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

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