Sr Specialist, Process Review (Remote)

Lensa; San Antonio (TX); Remote; USD 77,000 - 117,000; Full time

Job summary

An established industry player is seeking a skilled analyst to enhance operational processes and ensure compliance across departments. This role involves conducting in-depth assessments, collaborating with process owners, and serving as a vital resource for internal and external audits. With a focus on continuous improvement, you will leverage your analytical and problem-solving skills to recommend effective changes. Join a dynamic team dedicated to making impactful decisions in a supportive environment, where your expertise will contribute to the overall success of the organization.

Qualifications

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

Responsibilities

• Provide business process redesign and change management for operations.
• Conduct interviews and assess 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, 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 create business process documentation and workflows related to Core Operations functions.
• Serve as 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. Provide timely and accurate responses in written and verbal form.
• 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. Additional experience for Corporate Operations includes:
• Analytical 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 in operations or process-focused environments.
• Previous audit and/or oversight experience.

To all current Molina employees: If interested, 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.

Additional Details

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