Process Expert II

Process Expert II

Location: Hybrid. This role requires associates be in the 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.

*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 by participating in project and process work. This employee will be an expert in COB guidelines, including NAIC regulations and Medicare Secondary Payer Rules, applicable across all business lines.

How you will make an impact:

• Researches operations workflow problems and system irregularities
• 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.
• Develops tests, presents process improvement solutions for new systems.
• New accounts and other operational improvements; develops and leads project plans and communicates project status.

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 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.
• 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.
• Strong analytical and problem-solving abilities.
• Support user acceptance testing and contribute to data validation and reporting analysis.
• Proficient in data validation and reporting analysis.
• Ability to analyze workflows, processes, supporting systems and procedures and identifying improvements strongly preferred.

For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Job Level: Non-Management Exempt

Workshift: Job Family: BSP > Process Improvement