Business Consultant Commercial Claims Data Mining

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Business Consultant - Commercial Claims Data Mining

Hybrid: 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.

Carelon Payment Integrity is a proud member of the Elevance Health family of companies Carelon Insights formerly Payment Integrity is determined to recover eliminate and prevent unnecessary medical-expense spending.

Schedule: Monday - Friday

The Business Consultant is responsible for translating moderately complex and varied business needs into application software requirements. Possesses full technical knowledge of most phases of systems and business analysis and is able to consider the business implications of the application of technology to current and future business environments.

How you will make an impact:

• May lead teams of analysts assigned to complex projects.

• Analyze design and determines specific business requirements works directly with Query Developers to ensure requirements will be incorporated into recovery query design and validation.

• Consults with business partners concerning application and implementation of technology.

• Consults with business partners concerning processes procedures contracts processing rules and other system rules to create queries that identify Cost of Care and Total Program Savings opportunities.

• Obtains interprets and applies provider and member contract language to support the creation of Business Requirement Documents (BRD) that contribute to Cost of Care and Total Program Savings.

• Writes Business Requirement Documents (BRD) and able to perform Concept Verification for low to high complexity projects.

• Engage key stakeholders (RAC Vendors Provider COC leads etc.) and facilitate meetings (agenda objectives outcomes etc.).

• Coaches and mentors team members.

• Effectively communicate defects and/or enhancements to business and/or IT partners.

• Serves as POC on New Concepts as they are expanded across the Enterprise.

• Participate in and or lead special projects.

Minimum Requirements:

• BA/BS and minimum of 8 years business analysis experience which should include analysis and project management; or any combination of education and experience which would provide an equivalent background.

Preferred Skills Capabilities and Experiences:

• Demonstrated strong analytical and problem-solving skills with research-oriented approach.

• Ability to manage multiple projects in various stages and complexity levels to completion.

• Demonstrated meeting facilitation skills.

• Demonstrated ability to support Commercial States

• Knowledge of systems capabilities and business operations is strongly preferred.

• In-depth knowledge of WGS Commercial Claims processing or adjustments is required.

• In-depth knowledge of WGS Pricing Arrangements is preferred.

• Provider Contract and Member Benefit expertise highly preferred.

• Associates in this role are expected to have strong oral written and interpersonal communication skills problem-solving skills facilitation skills and analytical skills.

• Project management ability to manage multiple projects in various stages to completion.

• Fluent in MS Excel Word and Power Point.

If this job is assigned to any Government Business Division entity the applicant and incumbent fall under a sensitive position work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances segregation of duties principles role specific training monitoring of daily job functions and sensitive data handling instructions. Associates in these jobs must follow the specific policies procedures guidelines etc. as stated by the Government Business Division in which they are employed.

For candidates working in person or virtually in the below locations the salary* range for this specific position is $92064 to $100832

Location(s): New York Nevada California Colorado

In addition to your salary Elevance Health offers benefits such as a comprehensive benefits package incentive and recognition programs equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of 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.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location work experience education and/or skill level. Even within the range the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned vested and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus commission benefits or any other form of compensation and benefits that are allocable to a particular employee remains in the Companys sole discretion unless and until paid and may be modified at the Companys sole discretion consistent with the law.

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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 may contact for assistance. 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.