Process Expert II - Concept Growth/COB Discovery

Elevance Health • Mason, OH

2d • Hybrid

About The Position

Process Expert II - Concept Growth/COB Discovery Hybrid: This role requires associates to be in-office 122 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Process Expert II - Concept Growth/COB Discovery supports a single operations department 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.

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.
• Strong analytical and problem-solving abilities.
• Proficient in data validation and reporting analysis.

Nice To Haves

• 5-7 years of comprehensive experience in COB auditing, covering both CB and GB concepts.
• Expert in COB guidelines, including NAIC regulations and Medicare Secondary Payer Rules, applicable across all business lines.
• Proficient in developing, exploring, and executing SQL queries on complex COB concepts, utilizing extensive experience with data insights and auditing techniques.
• Skilled in conducting thorough investigation research and engaging in necessary outreach (e.g., OHI, CMS, employers, ESRs) to ensure accurate validation of primacy and eligibility updates.
• Adept at researching and analyzing data gaps and system inconsistencies to enhance efficiency and capture savings opportunities through prevention and recoveries.
• Capable of identifying innovative ideas, approaches, and processes to optimize savings and operational efficiency.
• Consistently uphold high standards of quality assurance.

Responsibilities

• 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.
• Support user acceptance testing and contribute to data validation and reporting analysis.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees