Grievance and Appeals and State Fair Hearing Program Business Change Manager, Senior

About the role

The role is required to be domiciled in the state of Kansas and is a hybrid position, requiring associates to be in-office 1 - 2 days per week.

Responsibilities

• Manage Provider Grievances, Provider Appeals, and Provider State Fair Hearings for the Kansas Health Plan.
• Work with management to identify and implement varied projects, programs, and plans supporting business unit and enterprise goals.
• Identify potential issues, project changes, and scope.
• Lead efforts to identify best practices.
• Identify impacted parties, business partners, and resources required.
• Develop and design processes and systems that support business needs.
• Design methods for integrating functions and processes.
• Conduct cost/benefit analyses.
• Build support for business change throughout the business unit.
• Ensure State Fair Hearing notices and case documentation are accurate and complete.
• Support all State Fair Hearing materials timely submission.
• Ensure all Member and Provider cases are appropriately tracked and reported, and records remain audit-ready.

Requirements

• A BA/BS in a related field and minimum of 8 years process improvement, business change, or project-related experience; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities & Experiences

• Experience with Provider Grievances, Appeals, administrative hearings, or other legal processes.
• Experience with accurate, complete, and timely regulatory documentation and submission.
• Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
• Experience as a legal assistant or paralegal or comparable education or employment experience.
• Experience in successfully developing and managing projects with fairly significant operating budgets and knowledge of process redesign.

Benefits

Elevance Health offers a range of market-competitive total rewards including 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, among others.

Pay

Details on pay are not specified in the job posting.

Schedule

The role is a hybrid position, requiring associates to be in-office 1 - 2 days per week.