Elevance Health
Anticipated End Date
2025-10-25
Position Title
Business Analyst III - Carelon Payment Integrity
Job Description Business Analyst III
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. Alternate locations may be considered.
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
Business Analyst III
is a member of our
Carelon Payment Integrity’s Data Mining Team , where we utilize advanced analytics to uncover anomalies and drive real savings. This position plays a critical role in uncovering claims overpayments and guiding clients through implementation of data‑driven insights. This individual will be data mining, finding anomalies and validating our findings for external clients.
How you will make an impact
Analyzes complex end user needs to determine optimal means of meeting those needs.
Determines specific business application software requirements to address complex business needs.
Develops project plans and identifies and coordinates resources, involving those outside the unit.
Works with programming staff to ensure requirements will be incorporated into system design and testing.
Acts as a resource to users of the software to address questions/issues.
May provide direction and guidance to team members and serves as an expert for the team.
Validates findings and presents results to team leads for informed decision‑making.
Serves as a key liaison between business consultants, data analysts, query developers, and project teams or clients if applicable, ensuring seamless communication and coordination.
Conducts root‑cause analysis and identifies patterns in large data sets to drive efficiency.
Researches and trends claim anomalies to enhance process accuracy.
Manages multiple projects simultaneously, meeting deadlines and business needs efficiently.
Minimum Requirements Requires a BA/BS and minimum of 5 years business analysis experience; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences
Prior experience in health insurance claims processing (e.g., coding, keying, adjusting) highly preferred.
Advanced MS Excel skills (pivot tables, VLOOKUP, formulas) highly preferred.
Strong analytical and research orientation with a knack for solving problems preferred.
Excellent communication (both written and verbal) and interpersonal skills preferred.
Proven ability to collaborate across departments preferred.
Ability to work independently in a dynamic environment and collaboratively preferred.
Coding certification (e.g., CPC) preferred.
Experience with client/vendor relations, customer service, or healthcare analytics a plus.
Job Level Non‑Management Exempt
Workshift 1st Shift (United States of America)
Job Family BSP > Business Support
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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2025-10-25
Position Title
Business Analyst III - Carelon Payment Integrity
Job Description Business Analyst III
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. Alternate locations may be considered.
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
Business Analyst III
is a member of our
Carelon Payment Integrity’s Data Mining Team , where we utilize advanced analytics to uncover anomalies and drive real savings. This position plays a critical role in uncovering claims overpayments and guiding clients through implementation of data‑driven insights. This individual will be data mining, finding anomalies and validating our findings for external clients.
How you will make an impact
Analyzes complex end user needs to determine optimal means of meeting those needs.
Determines specific business application software requirements to address complex business needs.
Develops project plans and identifies and coordinates resources, involving those outside the unit.
Works with programming staff to ensure requirements will be incorporated into system design and testing.
Acts as a resource to users of the software to address questions/issues.
May provide direction and guidance to team members and serves as an expert for the team.
Validates findings and presents results to team leads for informed decision‑making.
Serves as a key liaison between business consultants, data analysts, query developers, and project teams or clients if applicable, ensuring seamless communication and coordination.
Conducts root‑cause analysis and identifies patterns in large data sets to drive efficiency.
Researches and trends claim anomalies to enhance process accuracy.
Manages multiple projects simultaneously, meeting deadlines and business needs efficiently.
Minimum Requirements Requires a BA/BS and minimum of 5 years business analysis experience; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences
Prior experience in health insurance claims processing (e.g., coding, keying, adjusting) highly preferred.
Advanced MS Excel skills (pivot tables, VLOOKUP, formulas) highly preferred.
Strong analytical and research orientation with a knack for solving problems preferred.
Excellent communication (both written and verbal) and interpersonal skills preferred.
Proven ability to collaborate across departments preferred.
Ability to work independently in a dynamic environment and collaboratively preferred.
Coding certification (e.g., CPC) preferred.
Experience with client/vendor relations, customer service, or healthcare analytics a plus.
Job Level Non‑Management Exempt
Workshift 1st Shift (United States of America)
Job Family BSP > Business Support
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.
#J-18808-Ljbffr