Operations Expert

About the role

The Operations Expert 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.

Responsibilities

• Support as a Subject Matter Expert (SME) for Enrollment and Billing operations supporting assigned markets.
• Maintain compliance with State, regulatory, and contractual requirements for enrollment, billing, invoicing, reconciliation, and membership transactions.
• Participate in audit readiness activities, compliance reviews, corrective action plans, and implementation of process improvements.
• Collaborate with IT teams to investigate, troubleshoot, and resolve complex operational and system issues.
• Develop business requirements and support end-to-end testing, UAT, production validation, and implementation activities for system enhancements and regulatory changes.
• Support DOH and other State-mandated initiatives to ensure compliance with evolving State and Federal requirements.
• Analyze enrollment, billing, reconciliation, and membership data to identify trends, risks, operational impacts, and opportunities for process improvement.
• Develop and maintain operational reports, dashboards, membership analyses, and trend reporting to support leadership decision-making, membership growth, and retention strategies.
• Support critical member outreach campaigns, including new enrollment, renewal, and disenrollment outreach initiatives that support member engagement and retention efforts.
• Collaborate with Sales, Retention, Operations, IT, and external stakeholders to support membership growth and retention initiatives.
• Participate in audits, market meetings, and cross-functional workgroups to provide operational expertise and support regulatory compliance efforts.
• Identify opportunities for automation, workflow enhancements, and operational efficiencies that improve the member and customer experience.
• Provide training, guidance, and operational support to staff regarding workflow processes, regulatory changes, and system functionality.

Requirements

• Requires an AA/AS in Information Systems, Health Care Management or Business or related field and a minimum of 3 years of experience in an analytical role including a minimum of 1 year as an enrollment analyst; or any combination of education and experience which would provide an equivalent background.
• Experience supporting healthcare enrollment and billing operations.
• Knowledge of Medicaid, Commercial, Exchange, or Government Program enrollment and billing processes.
• Experience supporting audits, compliance activities, regulatory implementations, and operational process improvements.
• Strong analytical and problem-solving skills with the ability to evaluate operational and system impacts.
• Advanced Microsoft Excel skills, including pivot tables, formulas, reporting, and data analysis.
• Experience with SQL, Tableau, Power BI, or other reporting and analytical tools preferred.
• Experience gathering business requirements and supporting system testing and implementations.
• Strong communication, presentation, collaboration, and stakeholder management skills.
• Ability to manage multiple priorities and work effectively in a fast-paced, highly regulated environment.

Preferred Skills, Capabilities and Experiences

• Experience supporting healthcare enrollment and billing operations.
• Knowledge of Medicaid, Commercial, Exchange, or Government Program enrollment and billing processes.
• Experience supporting audits, compliance activities, regulatory implementations, and operational process improvements.
• Strong analytical and problem-solving skills with the ability to evaluate operational and system impacts.
• Advanced Microsoft Excel skills, including pivot tables, formulas, reporting, and data analysis.
• Experience with SQL, Tableau, Power BI, or other reporting and analytical tools preferred.
• Experience gathering business requirements and supporting system testing and implementations.
• Strong communication, presentation, collaboration, and stakeholder management skills.
• Ability to manage multiple priorities and work effectively in a fast-paced, highly regulated environment.

Benefits

This role offers 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.

Pay

Details on pay will be provided in the full job details.

Schedule

Details on schedule will be provided in the full job details.

Who We Are

Elevance 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 Work

At 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.

Equal Employment Opportunity

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.