• Job Description

  Req#: JR117927

  Anticipated End Date:

  2024-06-15

  Position Title:

  Process Expert II (US)

  Job Description:

  Location:

  Elevance Health supports a hybrid workplace model (virtual and office) with PulsePoint sites used for collaboration, community, and connection, with the minimum in-office commitment being 1-3 days in an office per week.

  Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

  Supports a single operations department by participating in project and process work. The successful candidate will have a deep understanding of claim processing, in-depth knowledge of health insurance policies, regulatory compliance, and the skill to implement effective operational processes.

  PRIMARY DUTIES:

  • 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.
  • Constantly monitor the effectiveness of the implemented processes, making necessary adjustments to achieve optimal productivity.
  • Collaborate with other team members to guarantee proper execution of processes.
  • Provide training and support to staff concerning new procedures and policies. Assure adherence to all government and agency regulations and standards.
  • Prepare reports on process operations and efficiency for management.
  • Respond to claim-related issues and queries promptly, ensuring a quality-focused resolution.

  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 Experience:

  • Ability to analyze workflows, processes, supporting systems and procedures and identifying improvements strongly preferred.
  • Proven self-starter with experience in claim processing, analyzing, and streamlining business operations.
  • Excellent problem-solving skills with the ability to develop effective process strategies.
  • Strong knowledge of medical terminology, codes, and health insurance policies.
  • Proficient in using claims processing software and MS Office Suite.
  • Exceptional communication, interpersonal, and leadership skills.

  Job Level:

  Non-Management Exempt

  Workshift:

  Job Family:

  BSP > Process Improvement

  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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

  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. 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 elevancehealthjobssupport@elevancehealth.com for assistance.

• About the company

  Elevance Health, Inc. is an American health insurance provider.

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