Elevance Health · 3 days ago
Claims Process Expert Sr. - Ohio MyCare
Columbus, OH
Full-time
Hybrid
Senior Level, Lead/Staff
$82K/yr - $123K/yr
8+ years expElevance Health is a health company dedicated to improving lives and communities, and they are seeking a Claims Process Expert Sr. to oversee the administration of claims processing and operational support functions for their Ohio Medicaid products. This role involves ensuring compliance with regulatory standards, managing the end-to-end claims process, and collaborating with various stakeholders to improve operational workflows.
HealthcareWellnessHealth InsuranceHealth CarePersonal Health
Responsibilities
Oversee the end-to-end claims process, including receipt, adjudication, payment, and performance reporting on claims timeliness, accuracy, backlog and provider payment compliance
Serve as the operational liaison with the state of Ohio, Provider Experience, and internal executive leadership
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
May perform duties as a lead when involved with enterprise wide initiatives/projects
Qualification
Required
Candidates are required to live in Ohio
This role requires associates to be in-office 1 - 2 days per week
Requires a BA/BS and minimum of 8 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
Oversee the end-to-end claims process, including receipt, adjudication, payment, and performance reporting on claims timeliness, accuracy, backlog and provider payment compliance
Serve as the operational liaison with the state of Ohio, Provider Experience, and internal executive leadership
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
May perform duties as a lead when involved with enterprise wide initiatives/projects
Preferred
Ability to analyze workflows, processes, supporting systems and procedures and identifying improvements strongly preferred
Experience with Dual Products: Medicaid and Medicare strongly preferred
Ohio state regulatory reporting experience preferred
Broad experience in claims Medicaid and/or Medicare within the state of Ohio is strongly preferred
Benefits
Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution
Merit increases
Paid holidays
Paid Time Off
Incentive bonus programs
Medical
Dental
Vision
Short and long term disability benefits
Stock purchase plan
Life insurance
Wellness programs
Financial education resources
Company
Elevance Health
Elevance Health is an integrated whole-health approach to help people in health journey and address their full range of needs.
10001+ employees
H1B Sponsorship
Elevance Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (488)
2024 (604)
2023 (660)
2022 (222)
Funding
Current Stage
Public CompanyTotal Funding
unknown2001-10-30IPO
Leadership Team
Gail K. Boudreaux
President and CEO
Geeta Wilson
Chief Technology Officer (CTO): Digital Health and Service Experience Platforms
Recent News
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