Sr Specialist, Process Review (Remote)

Lensa; Nampa (ID); Remote; USD 77,000 - 117,000; Full time

Job summary

A leading company in the IT Services sector is seeking a Mid-Senior level professional for business process redesign and change management. The role involves collaboration with various departments to ensure compliance and improve operational efficiency. Candidates should possess strong analytical skills and relevant experience in managed care operations.

Benefits

Competitive benefits and compensation

Qualifications

• Four years of proven analytical experience in operations or process-focused environments.
• Experience within managed care operations including enrollment and claims processing.

Responsibilities

• Provide business process redesign and change management for operations.
• Conduct interviews to assess internal business processes for compliance.

Skills

Analytical Skills

Communication

Collaboration

Education

Associate's Degree

Bachelor's Degree

Job description

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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 recommend process improvements.
• Summarize and document assessment outcomes and recommendations, ensuring clear communication to process owners and management.
• Collaborate with process owners to maintain or 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, 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 enrollment, encounter processing, provider and contract configuration, and claims processing.

Preferred Education

Bachelor's Degree.

Preferred Experience

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

To all current Molina employees: Please 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 / ANNUAL

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

Seniority level

• Mid-Senior level

Employment type

• Full-time

Job function

• Information Technology

Industries

• IT Services and IT Consulting