AddressDescription
Process Expert ll
Location : This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of our Elevance Health PulsePoint locations.
The Process Expert ll role supports a single operations department by participating in in depth auditing techniques, advanced primacy validation, maximize COB savings opportunities, project and process work.
How you will make an impact:
COB subject matter expert across all lines of business, processes, concepts & application of NAIC guidelines & Medicare secondary Payer Rules & regulations.
Performs in depth investigation research to identify existing gaps or untapped opportunities to drive incremental prevention savings & recoveries.
Assist with SQL query ideation.
Identify existing concept refinement or new concept opportunities.
Ownership of individual performance with inventory management and status workflow.
Performs targeted outreach (i.e., OHI, CMS, employers, ESRs, etc.) for accurate primacy validation & eligibility updates.
Ensure quality assurance standards consistently are met.
Assist with new process documentation to support operational growth and efficiency opportunities.
Minimum Requirements:
Requires a BA/BS and minimum of 5 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, Capabilities, and Experiences:
5-7 years of direct COB auditing experience across concepts & lines of business preferred.
SME COB knowledge of both NAIC guidelines & Medicare secondary Payer Rules & regulations across all lines of business preferred.
Strong analytical and problem solving experience preferred.
Excellent verbal/written communication skills preferred.
Excellent with multitasking and time management experience preferred.
Ability to analyze workflows, processes, supporting systems and procedures and identify improvements strongly preferred.
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. 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.comfor assistance.
