Process Expert II; Prior Authorization

Anticipated End Date:

Position Title: Process Expert II (Prior Authorization)

The Process Expert II (Prior Authorization) supports a single operations department by participating in project and process work. The role assists in the configuration of the prior authorization workflow tool, ensuring it is set up and maintained to support business operations effectively.

Location: Candidates that live in Ohio, Nevada, and Virginia are strongly preferred. Alternate locations may be considered if candidates reside within a commuting distance of an office.

Hybrid: This role requires associates to be in-office 1–2 days per week, fostering collaboration and connectivity while providing flexibility for productivity and work‑life balance. The approach combines structured office engagement with the autonomy of virtual work.

Shift: Standard business hours; rotating weekends with flex opportunities and shifts up to 9:00 pm, as needed.

• 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.
• Efficiently addresses and helps facilitate support tickets, ensuring any issues affecting business operations are promptly addressed to maintain system reliability.
• Handles and coordinates change requests, working closely with internal teams and external partners to implement necessary adjustments seamlessly.

Requires a BA/BS and a minimum of 5 years’ experience in business analysis, process improvement, or project coordination in a high-volume managed care operation (claims, customer service, enrollment, and billing), or an equivalent combination of education and experience.

• Ability to analyze workflows, processes, supporting systems, and procedures and identify improvements.
• Understanding of prior authorization processing.
• Working knowledge of PA Hub.
• Ability to work autonomously.
• Team-oriented.

For URAC‑accredited areas, the following professional competencies apply: strong oral, written, and interpersonal communication skills; problem‑solving skills; facilitation skills; and analytical skills.

Salary: The salary range for this position is $70,812 – $106,218.

Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution. The salary offered is based on legitimate, non‑discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

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.

Applicants who require accommodation to participate in the job application process may contact elevancehealthj for assistance.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.