Process Expert Sr - #16305

WellPoint is the nation's leading health benefits company serving the needs of approximately 28 million medical members nationwide.



Supports multiple operations departments by participating in project and process work. Essential duties include, but are not limited to: 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. Works with the Forecaster on claims trending and analysis.  Monitors and implements CMS changes related to MR, Appeals, Outreach - including working with Operations Experts to define work flow, writing policies and procedures, etc.  Provides subject matter expertise as needed to internal and external customers as related to MR, Appeals, and Outreach.  Supports each of the functional areas as needed - i.e. clinical support to nurses, etc.  Handles all projects - CAST, MMORP, etc for Medical Review, Appeals, and Education. Performs other duties as assigned.

BA degree in Nursing or equivalent and 8-10 years related experience (business analysis, process improvement, project management) required or equivalent combination of education and experience required. Previous experience in high-volume managed care operations (claims, customer service, enrollment and billing) required. Certification in process improvement, process design or project management may be required. Demonstrated ability to analyze existing and potential workflows, processes, supporting systems and procedures and identifying improvements required. Excellent written, oral and interpersonal communication skills required. Excellent analytical, strong PC skills and good problem solving skills required. Excellent project/decision facilitation skills required.