Claims Overpayment Analyst Lead

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Claims Overpayment Analyst Lead

Location: Norfolk VA; Tampa FL; or Hanover MD.

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.

The Claims Overpayment/Financial Operations Analyst Lead is responsible for leading the effort to identify analyze validate and avoid medical overpayments. The goal is to deliver measurable cost savings through expense recovery and cost avoidance. This will include translating basic business needs into application software requirements.

How you will make an impact:

Primary duties may include but are not limited to:

• Develops and executes complex data analysis.
• Works with programming staff to ensure requirements will be incorporated into system design and testing.
• Perform data mining utilizing CPT HCPCS DRG ICD-9 ICD-10 etc. to identify recovery opportunities.
• Provides decision support and procedural input to ensure that processing efficiency does not compromise internal control mechanisms.
• Validate overpayments complete Approach document and forward necessary files and documents for CCU Load.
• Documents and responds to any external audit requests.
• Ensures proper conversion or shutdown of legacy systems by developing and documenting enterprise solutions for successful transition to core processing systems.
• Research all resource documents and web-sites.
• Submit enhancement request for database updates.

Minimum Requirements:

• Requires a BA/BS in accounting or finance and a minimum of 5 years experience in a finance/health insurance field capacity and experience with relational databases and mainframe and client server report writers; or any combination of education and experience which would provide an equivalent background. Project management experience required.

Preferred skills capabilities & experiences:

• Healthcare business analysis experience preferred.
• Experience in using Facets SQL and MACESS highly preferred.
• Medical billing and/or claims processing experience is preferred.
• 2 years of experience with data analysis claims processing provider billing FWA investigations cost containment Medicare Medicaid MMP and/or MedSupp plans strongly preferred.
• Medical coding experience - CPT HCPCS ICD-9/10 coding preferred.
• CPC or applicable professional designation preferred.
• Proficient of Microsoft Office products most notably expertise in Excel for reporting Word PowerPoint Teams and Outlook strongly preferred.
• MBA CPA CMA CFA or applicable professional designation preferred.

For candidates working in person or virtually in the below locations the salary* range for this specific position is $87560 to $119400

Location: Maryland

In addition to your salary Elevance Health offers benefits such as a comprehensive benefits package incentive and recognition programs equity stockpurchaseand 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.

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