Sr Specialist, Process Review (Remote)

Lensa; Sterling Heights (MI); 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 various departments. This role involves conducting thorough assessments, collaborating with teams to document workflows, and acting as a liaison during audits. Ideal candidates will have a strong background in managed care operations and possess exceptional analytical and problem-solving skills. Join a dynamic team dedicated to improving business processes and making a significant impact in the healthcare sector. If you are passionate about driving change and optimizing operations, this opportunity is perfect for you.

Qualifications

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

Responsibilities

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

Skills

Analytical Skills

Problem-Solving Skills

Communication Skills

Education

Associate's Degree

Bachelor's Degree

Job description

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Job Description

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 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 effective communication (written and verbal) 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 and external auditors for all formal Core Operations audits that are not compliance-related.
• Coordinate, facilitate, and document audit walkthroughs.
• Research, collect, or generate requested documentation and provide timely, accurate responses in writing and verbally.
• Research and 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 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 proven analytical experience within an operations or process-focused environment.
• Previous audit and/or oversight experience.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina is 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