Sr Specialist, Process Review (Remote)

Lensa; New York (NY); 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 role involves analytical assessments, collaboration with departments, and serving as a liaison during audits. Candidates should possess strong analytical skills and relevant experience in managed care operations.

Qualifications

• Four years of proven analytical experience within an operations or process-focused environment.
• Experience within managed care operations.
• Knowledge of managed care enrollment, claims processing, and related functions.

Responsibilities

• Conduct interviews to assess internal business processes.
• Review and analyze information for compliance.
• Collaborate with process owners to maintain business process documentation.

Skills

Analytical skills

Problem-solving skills

Communication

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 a process or function and the corresponding documentation. Use analytical skills to identify variances. Use problem-solving skills and business knowledge to recommend process improvements.
• Summarize and document assessment outcomes and recommendations, ensuring they are communicated effectively to process owners and management.
• Collaborate with process owners to maintain and/or 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, accurate responses.
• Research and respond to clarifying questions from 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. For Corporate Operations:
• 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 all current Molina employees: Please apply for this position 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