Elevance Health
Business Architect Sr - Claims Systems
Elevance Health, Atlanta, Georgia, United States, 30383
Overview
Business Architect Sr - Claims Systems at Elevance Health. Location: This role requires in-office presence once per week with flexibility for remote work; alternate locations may be considered if within commuting distance. Policy notes apply for hybrid/virtual work and reasonable commuting distance requirements. The Business Architect Sr - Claims Systems will be part of Elevance Health’s National Operations Command Center (NOCC), which monitors end-to-end operational, experience, and financial performance across enterprise functions. The team leads root-cause analysis and develops permanent solutions for strategic, enterprise-impacting issues. How You Will Make An Impact
Support cost of care and other claims-based root-cause investigations using in-depth claims system and business process knowledge to evaluate claims system configuration and logic against expected workflows Conduct sophisticated data analysis and synthesize findings into root-cause contributors and their impact on organizational and stakeholder experience Recommend process and/or system enhancements to permanently resolve identified issues, convert business requirements into technical requirements, and manage handoff to technology implementation teams Provide linkages to other Enterprise Architecture groups and models, coordinate activities to achieve future state capabilities with Business Relationship Management (BRM) skills, and confirm solutions work as intended Lead reference architectures, Strategic Business Architecture (SBA) and Operational Business Architecture (OBA) to articulate future state direction and optimize the value chain Lead the Business Architecture portion of business blueprints, including guiding principles, defining capabilities, functional analysis/definition, value chain assessment, and organizational impact analysis Create initiatives for enterprise-wide functional analysis to identify efficiency or rationalization opportunities and continually analyze business capabilities to support architecture components Review project assessment against business architecture artifacts and blueprints, integrating into the architecture governance process Translate strategic decisions into operational and process-focused plans for a market segment Analyze and apply emerging organizational paradigms aligned to strategic needs Communicate and build consensus with executives, technologists, end users, and operations Minimum Requirements
BA/BS degree in Information Technology, Computer Science or related field Minimum of 7 years experience in business analysis and strategic planning, IT operations, IT planning, IT leadership, or strategic and technical architecture; or equivalent background Preferred Skills, Capabilities, And Experiences
3+ years of experience with Claims System SME (WGS/FACETS) strongly preferred Experience with systems such as EDI/EDINET, SQL, JIRA, FACETS (CENTRAL/GBD), WGS MAINFRAME & CIW, WEBSTRAT, AO Tool, .Net UI, Claims Workstation Pega UI Claims process and data knowledge including: Claims Train data, CAST Train data; E2E claim lifecycle vetting; CPEC-Claims Payment Extract and Capitation; CIFT, CFE; GBD IT Pre/Post-Adjudication; UM MATCH LOGIC; PROVIDER/PRICING CONFIG utilization Data & Analytics experience with tools such as EdWard, OPAL, OBI, EDI About Elevance Health
Elevance Health is a health company dedicated to improving lives and communities. We are a Fortune 25 company focused on making healthcare simpler and driving impact for our members, associates, communities and the business. Working at Elevance Health
We offer market-competitive total rewards, including merit increases, paid holidays, Paid Time Off, incentive bonus programs, medical, dental, vision, disability benefits, 401(k) with match, stock purchase plan, life insurance, wellness programs and financial education resources. Elevance Health operates a Hybrid Workforce Strategy; associates are expected to work at an Elevance Health location at least once per week unless specified otherwise. Time onsite requirements will be discussed during the hiring process. We require all new candidates in certain patient/member-facing roles to be vaccinated against COVID-19 and Influenza where legally required. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration without regard to protected characteristics. Accommodation requests may be submitted to elevancehealthjobssupport@elevancehealth.com. EEO Statement
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
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Business Architect Sr - Claims Systems at Elevance Health. Location: This role requires in-office presence once per week with flexibility for remote work; alternate locations may be considered if within commuting distance. Policy notes apply for hybrid/virtual work and reasonable commuting distance requirements. The Business Architect Sr - Claims Systems will be part of Elevance Health’s National Operations Command Center (NOCC), which monitors end-to-end operational, experience, and financial performance across enterprise functions. The team leads root-cause analysis and develops permanent solutions for strategic, enterprise-impacting issues. How You Will Make An Impact
Support cost of care and other claims-based root-cause investigations using in-depth claims system and business process knowledge to evaluate claims system configuration and logic against expected workflows Conduct sophisticated data analysis and synthesize findings into root-cause contributors and their impact on organizational and stakeholder experience Recommend process and/or system enhancements to permanently resolve identified issues, convert business requirements into technical requirements, and manage handoff to technology implementation teams Provide linkages to other Enterprise Architecture groups and models, coordinate activities to achieve future state capabilities with Business Relationship Management (BRM) skills, and confirm solutions work as intended Lead reference architectures, Strategic Business Architecture (SBA) and Operational Business Architecture (OBA) to articulate future state direction and optimize the value chain Lead the Business Architecture portion of business blueprints, including guiding principles, defining capabilities, functional analysis/definition, value chain assessment, and organizational impact analysis Create initiatives for enterprise-wide functional analysis to identify efficiency or rationalization opportunities and continually analyze business capabilities to support architecture components Review project assessment against business architecture artifacts and blueprints, integrating into the architecture governance process Translate strategic decisions into operational and process-focused plans for a market segment Analyze and apply emerging organizational paradigms aligned to strategic needs Communicate and build consensus with executives, technologists, end users, and operations Minimum Requirements
BA/BS degree in Information Technology, Computer Science or related field Minimum of 7 years experience in business analysis and strategic planning, IT operations, IT planning, IT leadership, or strategic and technical architecture; or equivalent background Preferred Skills, Capabilities, And Experiences
3+ years of experience with Claims System SME (WGS/FACETS) strongly preferred Experience with systems such as EDI/EDINET, SQL, JIRA, FACETS (CENTRAL/GBD), WGS MAINFRAME & CIW, WEBSTRAT, AO Tool, .Net UI, Claims Workstation Pega UI Claims process and data knowledge including: Claims Train data, CAST Train data; E2E claim lifecycle vetting; CPEC-Claims Payment Extract and Capitation; CIFT, CFE; GBD IT Pre/Post-Adjudication; UM MATCH LOGIC; PROVIDER/PRICING CONFIG utilization Data & Analytics experience with tools such as EdWard, OPAL, OBI, EDI About Elevance Health
Elevance Health is a health company dedicated to improving lives and communities. We are a Fortune 25 company focused on making healthcare simpler and driving impact for our members, associates, communities and the business. Working at Elevance Health
We offer market-competitive total rewards, including merit increases, paid holidays, Paid Time Off, incentive bonus programs, medical, dental, vision, disability benefits, 401(k) with match, stock purchase plan, life insurance, wellness programs and financial education resources. Elevance Health operates a Hybrid Workforce Strategy; associates are expected to work at an Elevance Health location at least once per week unless specified otherwise. Time onsite requirements will be discussed during the hiring process. We require all new candidates in certain patient/member-facing roles to be vaccinated against COVID-19 and Influenza where legally required. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration without regard to protected characteristics. Accommodation requests may be submitted to elevancehealthjobssupport@elevancehealth.com. EEO Statement
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
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