Sr Specialist, Process Review (Remote)

Lensa; Warren (MI); Remote; USD 77,000 - 117,000; Full time

Job summary

A leading career site is seeking professionals for Molina Healthcare. The role involves business process redesign, ensuring compliance with policies, and serving as a liaison for audits. Candidates should have strong analytical skills and experience in operations.

Benefits

Competitive benefits and compensation package

Qualifications

• Four years of proven analytical experience in an operations or process-focused environment.
• Experience within managed care operations, including enrollment and claims processing.

Responsibilities

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

Skills

Analytical Skills

Problem-Solving Skills

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. This includes 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, ensuring compliance with organizational Policies and Procedures, Standard Operating Procedures, and other internal guidelines.
• Review, research, analyze, and evaluate information to assess compliance between processes and the corresponding documentation. Use analytical skills to identify variances and problem-solving skills 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 or create business process documentation and workflows related to Core Operations functions.
• Serve as a liaison between Core Operations and auditors for all formal audits, including non-compliance related audits.
• Coordinate, facilitate, and document audit walkthroughs.
• Research, collect, or generate documentation as requested 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 in an operations or process-focused environment.
• For Corporate Operations: Experience within managed care operations, including enrollment, encounter processing, 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 an operations or process-focused environment.
• Previous audit and/or oversight experience.

To all current Molina employees: If interested, 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.