Sr Specialist, Process Review (Remote)

Lensa; Rio Rancho (NM); Remote; USD 77,000 - 117,000; Full time

Job summary

A leading company in the IT Services and Consulting industry is seeking a mid-senior level professional to enhance business processes through analysis and compliance. The role involves collaboration across departments, documentation, and serving as a liaison for audits. Ideal candidates will have a strong background in operations, particularly in managed care, and possess an analytical mindset. Competitive salary and benefits offered.

Benefits

Competitive benefits

Qualifications

• Four years of analytical experience in operations or process-focused environment.
• Experience within managed care operations.

Responsibilities

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

Skills

Compliance

Process Improvement

Documentation

Communication

Education

Associate's Degree

Bachelor's Degree

Job description

Job Description

Responsible for providing business process redesign, communication, and change management for operations. This includes the backend operationalization of policies, standardization of system setup, 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, ensuring compliance with organizational Policies, Procedures, and SOPs.
• Review, analyze, and evaluate information to assess compliance, identify variances, and recommend process improvements.
• Summarize and document assessment outcomes and communicate them effectively 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 for audits, coordinate walkthroughs, and respond to audit requests and questions.

Job Qualifications

Required Education: Associate's Degree or two years of equivalent experience.

Required Experience: Four years of analytical experience in an operations or process-focused environment, including experience within managed care operations such as enrollment, encounter processing, provider/configuration, and claims processing.

Preferred Education: Bachelor's Degree.

Preferred Experience: Six years of analytical experience, with previous audit or oversight experience.

Additional Information

This position is full-time, mid-senior level, within the Information Technology job function, in the IT Services and Consulting industry. Salary range: $77,969 - $116,835 annually. Molina Healthcare offers competitive benefits and is an Equal Opportunity Employer.