Operations Expert

Elevance Health•Indianapolis, IN

9d•Hybrid

About The Position

The Operations Expert is responsible for supporting Enrollment and Billing operations for assigned markets. This role serves as a subject matter expert for enrollment, billing, compliance, audit readiness, operational reporting, membership analysis, system implementations, and State-mandated initiatives. The position partners closely with Operations, IT, Sales, Retention, Health Plans, State agencies, and cross-functional business partners to ensure accurate enrollment and billing processing, regulatory compliance, and successful implementation of operational and system changes. This role supports membership growth and retention initiatives through operational oversight, issue resolution, membership reporting and analysis, process improvements, member outreach support, and implementation of State and Federal initiatives.

Requirements

Requires an AA/AS in Information Systems, Health Care Management or Business or related field and a minimum of 3 years of experience in an analytical role including a minimum of 1 year as an enrollment analyst; or any combination of education and experience which would provide an equivalent background.

Nice To Haves

Experience supporting healthcare enrollment and billing operations.
Knowledge of Medicaid, Commercial, Exchange, or Government Program enrollment and billing processes.
Experience supporting audits, compliance activities, regulatory implementations, and operational process improvements.
Strong analytical and problem-solving skills with the ability to evaluate operational and system impacts.
Advanced Microsoft Excel skills, including pivot tables, formulas, reporting, and data analysis.
Experience with SQL, Tableau, Power BI, or other reporting and analytical tools preferred.
Experience gathering business requirements and supporting system testing and implementations.
Strong communication, presentation, collaboration, and stakeholder management skills.
Ability to manage multiple priorities and work effectively in a fast-paced, highly regulated environment.

Responsibilities

Serve as a Subject Matter Expert (SME) for Enrollment and Billing operations supporting assigned markets.
Monitor enrollment, billing, invoicing, reconciliation, and membership transactions to ensure compliance with State, regulatory, and contractual requirements.
Support audit readiness activities, compliance reviews, corrective action plans, and implementation of process improvements.
Partner with IT teams to investigate, troubleshoot, and resolve complex operational and system issues.
Develop business requirements and support end-to-end testing, user acceptance testing (UAT), production validation, and implementation activities for system enhancements and regulatory changes.
Support Department of Health (DOH) and other State-mandated initiatives to ensure compliance with evolving State and Federal requirements.
Analyze enrollment, billing, reconciliation, and membership data to identify trends, risks, operational impacts, and opportunities for process improvement.
Develop and maintain operational reports, dashboards, membership analyses, and trend reporting to support leadership decision-making, membership growth, and retention strategies.
Support critical member outreach campaigns, including new enrollment, renewal, and disenrollment outreach initiatives that support member engagement and retention efforts.
Collaborate with Sales, Retention, Operations, IT, and external stakeholders to support membership growth and retention initiatives.
Participate in audits, market meetings, and cross-functional workgroups to provide operational expertise and support regulatory compliance efforts.
Identify opportunities for automation, workflow enhancements, and operational efficiencies that improve the member and customer experience.
Provide training, guidance, and operational support to staff regarding workflow processes, regulatory changes, and system functionality.