Claims Process Expert Sr Ohio MyCare
Listed on 2026-01-30
-
Healthcare
Healthcare Management, Healthcare Administration
Anticipated End Date
Position TitleClaims Process Expert Sr.
- Ohio My Care
Candidates must live in Ohio. This role requires in‑office 1‑2 days per week with hybrid flexibility.
Job DescriptionThe MyCare Ohio Plan delivers high‑quality, trauma‑informed, culturally competent coordination for all members. The Claims Process Expert Sr. oversees claims administration and operational support to ensure compliance with Ohio Medicaid standards. Responsibilities include researching provider inquiries, configuring rate‑related claims, ensuring resolution success, and reporting against State Prompt Pay and Claims Issue requirements.
How You Will Make an Impact- Oversee end‑to‑end claims, including receipt, adjudication, payment, and performance reporting.
- Serve as operational liaison with Ohio state, Provider Experience, and executive leadership.
- Research workflow problems and system irregularities.
- Develop, test, and present process improvement solutions for new systems and operational improvements.
- Lead project plans and communicate status.
- Provide process direction for major project work.
- Guide process experts.
- Lead enterprise‑wide initiatives when involved.
- BA/BS and 8+ years in business analysis, process improvement, and project coordination in a high‑volume managed care operation (claims, customer service, enrollment, billing).
- Advanced workflow analysis and improvement.
- Experience with Medicaid and Medicare dual products.
- Ohio state regulatory reporting experience.
- Strong claims Medicaid and/or Medicare experience in Ohio.
Salary range: $81,760.00 to $ for this position.
BenefitsComprehensive benefits package, equity stock purchase, 401(k) contributions, and incentive programs as eligible.
Equal Employment OpportunityElevance Health is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender identity or expression, marital status, national origin, race, religion, sex, sexual orientation, or veteran status. Applicants who require accommodation may contact elevancehealthj
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