Process Expert Senior GrowthCOB Discovery

Anticipated End Date:

Position Title:

Job Description:

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.

Minimum Qualifications:

• 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.

Preferred Skills Capabilities and Experiences:

• 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.

Job Level:

Workshift:

Job Family:

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes including those submitted to hiring managers are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy power our business outcomes and drive our shared success - for our consumers our associates our communities and our business.

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.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager associates are required to work at an Elevance Health location at least once per week and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age citizenship status color creed disability ethnicity genetic information gender (including gender identity and gender expression) marital status national origin race religion sex sexual orientation veteran status or any other status or condition protected by applicable federal state or local laws. Applicants who require accommodation to participate in the job application process may contact for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws including but not limited to the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 Florida Agency for Health Care Administration .

NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13 the posting will automatically come down on 3/12 at 11:59:59 other words the job is posted until 3/13 not through 3/13.

Required Experience:

Senior IC