Process Expert Senior - Growth/COB Discovery

Elevance Health • Mason, OH

3d • Hybrid

About The Position

Process Expert Senior - Growth/COB Discovery Hybrid: 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 Senior - Growth/COB Discovery 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.

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.

Nice To Haves

• 8-10 years of extensive experience in COB auditing with complex concepts, covering both CB and GB.
• Expertise in COB, including thorough understanding of NAIC guidelines and Medicare Secondary Payer Rules across all business sectors.
• Advanced skills in developing, exploring, and executing SQL queries on intricate COB concepts, utilizing deep experience with data insights and auditing methods.
• Proficient in conducting detailed investigative research and performing necessary outreach (e.g., OHI, CMS, employers, ESRs) to ensure accurate validation of primacy and LL updates.
• Ability to generate and implement innovative ideas, approaches, and processes to enhance savings opportunities and operational efficiencies.
• Strong 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.
• Skilled in identifying refinements to existing concepts or newly devised logic opportunities.
• Supportive of UAT testing and proficient in data validation and reporting analysis.
• Capable of handling ad-hoc enterprise reporting requests concerning COB.

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.
• 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.

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