Process Expert Senior
Elevance Health

Job Info

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Process Expert Senior - Concept Growth & Discovery - Coordination of Benefits

Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.

Hybrid Workplace Strategy: 1-2 days in office per week

The Process Expert Senior supports multiple operations departments by participating in project and process work.

How you will make an impact:

• Researches operations workflow problems and system irregularities; develops, tests, presents process improvement solutions for new systems, new accounts and other operational improvements
• Develops and leads project plans and communicates project status
• Provides process direction and decision making for all minor and major project work; provides guidance to process experts.
• May perform duties as a lead when involved with enterprise wide initiatives/projects.
• Performs advanced SQL query ideation, exploration, & execution across COB concepts by leveraging in depth experience with data insights, auditing techniques & SME COB knowledge of both NAIC guidelines & Medicare secondary Payer Rules & regulations.
• Perform targeted in depth investigation research across complex and high value concepts and when required perform outreach for accurate primacy validation & eligibility updates.
• Identify existing concept refinement or new logic opportunities.
• Fosters and implements new ideas, approaches, processes to maximize savings opportunities & operational efficiencies.
• Assists team with ensuring new concepts are achieving desired goals & quality standards.
• Perform quality assurance reviews and provide feedback when necessary.
• Assists with UAT testing.
• Assists with data validation of external partnership processes.
• Assists with ad-hoc COB enterprise reporting requests.

Minimum Requirements:

Requires a BA/BS and minimum of 8 years experience in business analysis, process improvement, project coordination in a high-volume managed care operation (claims, customer service, enrollment and billing); or any combination of education and experience, which would provide an equivalent background.

Preferred Skills and Abilities:

• 8-10 years of extensive experience in comprehensive COB auditing with complex concepts, covering across all lines of business.
• Subject matter expert in every aspect of COB, with a comprehensive understanding of all NAIC guidelines and Medicare Secondary Payer Rules across all business sectors
• Advanced COB SQL query ideation experience.
• Proficient in conducting detailed investigative research and performing necessary outreach (e.g., OHI, CMS, employers, ESRs) to ensure accurate validation of order of benefits and eligibility updates
• Ability to generate and implement innovative ideas, approaches, and processes to enhance savings opportunities and operational efficiencies.
• Exceptional analytical and problem-solving expertise.
• Excellent communication skills, both verbal and written.
• Capable of re-auditing to identify opportunities for training and providing constructive feedback.
• Experienced in training, coaching, and mentoring others.
• Supportive of UAT testing and proficient in data validation and reporting analysis.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.

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