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Process Expert II
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Anticipated End Date: Position Title:Process Expert II - Coordination of Benefits (COB)Job Description:Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending.Process Expert II - Coordination of Benefits (COB)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 II - Coordination of Benefits (COB) 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.Conduct thorough investigations of complex, high-value concepts to maximize COB savings in both prevention and recovery across all lines of business.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 across all lines of business.Subject matter expert in all 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.Identify innovative ideas, approaches, and processes to optimize savings and operational efficiency.COB SQL query ideation experience.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.Job Level:Non-Management ExemptWorkshift:1st Shift (United States of America)Job Family:BSP > Process ImprovementPlease 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 AreElevance 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 WorkAt 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.
