Process Expert II

Elevance Health • Hanover, MD

2d • Hybrid

About The Position

Process Expert II Location: Hanover, Maryland Hybrid 1: This role requires associates to be in-office 1 - 2 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 supports a single operations department (Maryland Medicaid) participating in project and process work. This person will work closely with risk adjustment, finance teams, and care management teams to both improve execution and efficiency of submissions to the state and the associated remediation and coordination of activities related to member program benefit design. This includes but is not limited to: HIV/AIDS, Very low birth rate (newborns), renal, aged blind and/or disabled individuals. How you will make an impact: Primary duties may include, but are not limited to: 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. Supports premium optimization efforts specifically the HIV/AIDS workstream and will have primary responsibility for approved submissions to the state both current month-over-month and retro up to 24 months. This position could take on the following responsibilities: Newborn HIV, VLBW, OB kick-payment submissions (“Phase II”) as well as SSI conversions, ESRD conversions, wraparound FQHC payments, Specialty Drug carveouts (“Phase III”).

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.

Nice To Haves

• Ability to analyze workflows, processes, supporting systems and procedures and identifying improvements strongly preferred.
• Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

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
• Supports premium optimization efforts specifically the HIV/AIDS workstream and will have primary responsibility for approved submissions to the state both current month-over-month and retro up to 24 months
• Newborn HIV, VLBW, OB kick-payment submissions (“Phase II”) as well as SSI conversions, ESRD conversions, wraparound FQHC payments, Specialty Drug carveouts (“Phase III”)

Benefits

• Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

What This Job Offers

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