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Process Expert II - Clinical Grievance and AppealsL ocation: This position will work a hybrid model (remote and office). The ideal candidate must live within 50 miles of one of our Elevance Health PulsePoint locations listed on the requisition.The Process Expert II supports a single operations department 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.
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:
Ability to analyze workflows, processes, supporting systems and procedures and identifying improvements strongly preferred.
Experience in a healthcare or health plan setting most notably in Grievance & Appeals, Business Analytics and/or Claims strongly preferred.
Analytical, organizational, and problem-solving skills strongly preferred.
Certification in in process improvement or project management strongly preferred.
Excellent written, oral, presentation and interpersonal communication skills with the proven ability to negotiate expectations between multiple parties highly preferred.
Experience and knowledge in WGS, Solution Central, NextGen and/or PEGA systems strongly preferred.
Proficient of Microsoft Office products, most notably expertise in Word, Excel, PowerPoint, Teams, and Outlook strongly preferred.
