Sr Specialist, Process Review (Remote)

Lensa; Mesa (AZ); Remote; USD 77,000 - 117,000; Full time

Job summary

An established industry player is seeking a detail-oriented professional to lead business process redesign and change management initiatives. This role is pivotal in ensuring compliance and operational efficiency across various departments. The ideal candidate will have a strong analytical background, with experience in managed care and operational processes. You will collaborate with key stakeholders to document and improve workflows, serving as a vital resource for both internal teams and auditors. Join this dynamic team and make a significant impact on organizational success!

Qualifications

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

Responsibilities

• Provide business process redesign and change management for operations.
• Conduct audits and ensure compliance with internal guidelines.

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 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 problem-solving skills to recommend process improvements.
• 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.
• Serve as liaison between core operations and auditors for all formal audits, including non-compliance audits.
• Coordinate, facilitate, and document audit walkthroughs.
• Research and compile requested documentation; 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 in an operations or process-focused environment.
• For corporate operations: experience within managed care, knowledge of enrollment, encounter processes, provider and contract management, claims processing, etc.

Preferred Education

Bachelor's Degree.

Preferred Experience

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

Interested current Molina employees should apply through the intranet.

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

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

• Compensation varies 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