Operations Expert

Anticipated End Date:

Position Title:

Job Description:

Operations Expert

Location: This 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.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

PLEASE NOTE: This position is not eligible for current or future visa sponsorship

The Operations Expert is responsible for supporting Enrollment and Billing operations for assigned markets. This role serves as a subject matter expert for enrollment, billing, compliance, audit readiness, operational reporting, membership analysis, system implementations, and State-mandated initiatives. The position partners closely with Operations, IT, Sales, Retention, Health Plans, State agencies, and cross-functional business partners to ensure accurate enrollment and billing processing, regulatory compliance, and successful implementation of operational and system changes.

This role supports membership growth and retention initiatives through operational oversight, issue resolution, membership reporting and analysis, process improvements, member outreach support, and implementation of State and Federal

How You Will Make an Impact:

• Serve as a Subject Matter Expert (SME) for Enrollment and Billing operations supporting assigned markets.
• Monitor enrollment, billing, invoicing, reconciliation, and membership transactions to ensure compliance with State, regulatory, and contractual requirements.
• Support audit readiness activities, compliance reviews, corrective action plans, and implementation of process improvements.
• Partner with IT teams to investigate, troubleshoot, and resolve complex operational and system issues.
• Develop business requirements and support end-to-end testing, user acceptance testing (UAT), production validation, and implementation activities for system enhancements and regulatory changes.
• Support Department of Health (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.

Minimum 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.

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.

Job Level:

Workshift:

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Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

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.

We offer 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.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local 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 should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

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

NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13.