Elevance Health
Business Consultant - Carelon Payment Integrity
Elevance Health, Atlanta, Georgia, United States, 30383
Position Overview
Business Consultant - Carelon Payment Integrity
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. Alternate locations may be considered.
Per 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.
How you will make an impact
May lead teams of analysts assigned to complex projects.
Determines specific business application software requirements to address complex and varied business needs.
Analyzes and designs solutions to address complex and varied business needs.
Consults with business partners concerning application and implementation of technology.
Lead client consultations to identify and resolve payment integrity issues.
Analyze complex claim scenarios and business rules to uncover overpayments.
Guide cross‑functional teams through the development and implementation of recovery strategies.
Design business solutions to address diverse client requirements.
Partner with query developers to refine logic based on client data and operational feedback.
Facilitate internal and external meetings, ensuring alignment across stakeholders.
Document findings, track projects, and manage timelines to successful delivery.
Minimum Requirements Requires a 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
Prior experience in healthcare claims, payment integrity, or consulting highly preferred.
Strong understanding of claims processing, coding practices, reimbursement policies, and payer‑provider contracting preferred.
Demonstrated ability to work directly with clients and build long‑term relationships preferred.
Advanced MS Excel capabilities required (pivot tables, VLOOKUP, formulas) highly preferred.
Experience leading projects and managing cross‑functional stakeholders preferred.
Coding certification (e.g., CPC) is strongly preferred.
Strong verbal and written communication skills are highly preferred.
Ability to translate technical findings into actionable business strategies preferred.
Experience with client/vendor relations, customer service, or healthcare analytics a plus.
Job Details Job Level:
Non‑Management Exempt
Workshift:
1st Shift (United States of America)
Job Family:
BSP > Business Support
Equal Employment Opportunity 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 elevancehealthjobssupport@elevancehealth.com 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.
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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. Alternate locations may be considered.
Per 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.
How you will make an impact
May lead teams of analysts assigned to complex projects.
Determines specific business application software requirements to address complex and varied business needs.
Analyzes and designs solutions to address complex and varied business needs.
Consults with business partners concerning application and implementation of technology.
Lead client consultations to identify and resolve payment integrity issues.
Analyze complex claim scenarios and business rules to uncover overpayments.
Guide cross‑functional teams through the development and implementation of recovery strategies.
Design business solutions to address diverse client requirements.
Partner with query developers to refine logic based on client data and operational feedback.
Facilitate internal and external meetings, ensuring alignment across stakeholders.
Document findings, track projects, and manage timelines to successful delivery.
Minimum Requirements Requires a 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
Prior experience in healthcare claims, payment integrity, or consulting highly preferred.
Strong understanding of claims processing, coding practices, reimbursement policies, and payer‑provider contracting preferred.
Demonstrated ability to work directly with clients and build long‑term relationships preferred.
Advanced MS Excel capabilities required (pivot tables, VLOOKUP, formulas) highly preferred.
Experience leading projects and managing cross‑functional stakeholders preferred.
Coding certification (e.g., CPC) is strongly preferred.
Strong verbal and written communication skills are highly preferred.
Ability to translate technical findings into actionable business strategies preferred.
Experience with client/vendor relations, customer service, or healthcare analytics a plus.
Job Details Job Level:
Non‑Management Exempt
Workshift:
1st Shift (United States of America)
Job Family:
BSP > Business Support
Equal Employment Opportunity 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 elevancehealthjobssupport@elevancehealth.com 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.
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