Sr Specialist, Process Review (Remote)

Lensa; Savannah (GA); Remote; USD 77,000 - 117,000; Full time

Job summary

An established industry player is seeking a skilled professional to enhance business processes and ensure compliance across operations. This role involves conducting thorough assessments, collaborating with process owners, and serving as a vital resource for all departments. With a focus on analytical and problem-solving skills, you'll be instrumental in driving process improvements and facilitating audits. Join a dynamic team where your expertise will contribute to operational excellence and impactful change. If you are passionate about optimizing processes and making a difference in the healthcare sector, this opportunity is for you.

Qualifications

• 4+ years of analytical experience in operations or process-focused environments.
• Experience in managed care operations including claims processing.

Responsibilities

• Provide business process redesign and change management for operations.
• Serve as a liaison between core operations and auditors.

Skills

Analytical Skills

Problem-Solving Skills

Communication Skills

Education

Associate's Degree

Bachelor's Degree

Job description

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 Summary

Responsible for providing business process redesign, communication, and change management for operations. 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 within a department or function to ensure compliance with organizational Policies and Procedures, Standard Operating Procedures, and other guidelines.
• Review, research, analyze, and evaluate information to assess compliance between a process or function and the written documentation. Use analytical skills to identify variances and problem-solving skills for process improvement.
• Summarize and document assessment outcomes and recommendations, ensuring proper communication 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 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.
• Additional experience in managed care operations, including enrollment, encounter processes, provider and contract configuration, claims processing, etc.

Preferred Education

Bachelor's Degree.

Preferred Experience

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

Interested current Molina employees should apply through the intranet. Molina Healthcare offers competitive benefits. We are an Equal Opportunity Employer (EOE) M/F/D/V.

Additional Details

• Pay Range: $77,969 - $116,835 annually (may vary based on location, experience, education, skills).
• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Information Technology
• Industries: IT Services and IT Consulting