Sr Specialist, Process Review (Remote)

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

Job summary

An established industry player is seeking a skilled professional to enhance business processes through effective communication and change management. This role involves conducting thorough assessments of internal operations to ensure compliance and identify improvement opportunities. With a focus on managed care operations, you will collaborate with various departments, serving as a vital resource for policy standardization and audit facilitation. Join a dynamic team where your analytical skills will drive significant operational enhancements and contribute to a culture of excellence.

Qualifications

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

Responsibilities

• Provide business process redesign and change management for operations.
• Collaborate with process owners to maintain business process documentation.

Skills

Analytical Skills

Problem-Solving Skills

Communication Skills

Business Process Documentation

Compliance Knowledge

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 written documentation. Use analytical skills to identify variances. Apply problem-solving skills and business knowledge to recommend process improvements.
• Summarize and document assessment outcomes and recommendations, ensuring clear communication 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 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 in writing and verbally.
• 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. For Corporate Operations:
• Experience within managed care operations.
• Knowledge of managed care enrollment processes, 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.

Current Molina employees interested in applying should do so through the intranet job listing.

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

Additional Information

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Information Technology
• Industries: IT Services and IT Consulting

Referrals can increase your chances of interviewing at Lensa by 2x.

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