Process Expert II - Concept Growth/COB Discovery

About This Role

This role supports a single operations department by participating in project and process work. The Process Expert II researches operations workflow problems and system irregularities to develop and implement process improvement solutions.

Responsibilities

• Research operations workflow problems and system irregularities
• Develop, test, and present process improvement solutions for new systems, new accounts, and other operational improvements
• Develop and lead project plans
• Communicate project status
• Conduct thorough investigation research and engage in necessary outreach to ensure accurate validation of primacy and eligibility updates
• Research and analyze data gaps and system inconsistencies to enhance efficiency and capture savings opportunities
• Identify innovative ideas, approaches, and processes to optimize savings and operational efficiency
• Support user acceptance testing and contribute to data validation and reporting analysis
• Uphold high standards of quality assurance

Requirements

• BA/BS degree
• 5+ years experience in business analysis, process improvement, project coordination in a high-volume managed care operation (claims, customer service, enrollment and billing)

Qualifications

• BA/BS
• 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)

Nice to Have

• 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
• Proficient in developing, exploring, and executing SQL queries on complex COB concepts, utilizing extensive experience with data insights and auditing techniques
• Strong analytical and problem-solving abilities
• Proficient in data validation and reporting analysis

Skills

* Required skills

Benefits