Elevance Health
Business Architect Senior - Government Claims
Elevance Health, Atlanta, Georgia, United States, 30383
Business Architect Senior – Government Claims
Location:
This role requires associates to be in‑office one day 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.
Elevance Health’s National Operations Command Center (NOCC)
is responsible for end‑to‑end monitoring of operational, experience and financial performance across enterprise functions, proactively identifying and permanently solving issues with deep root‑cause data analysis.
How You Will Make An Impact
Support cost‑of‑care and other provider‑based root‑cause investigations leveraging intimate provider system and business process knowledge to audit system configuration and end‑to‑end inventory lifecycle for potential errors.
Conduct sophisticated data & analytics reports and synthesize findings on root‑cause contributors and organizational and/or stakeholder experience impact.
Based on system root‑cause findings, recommend process and system enhancements to permanently solve identified issues, converting business requirements into technical requirements and managing the handoff to technology implementation teams.
Provide linkages to other Enterprise Architecture groups and models, coordinate and align activities to achieve the 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) that articulate a future state direction to optimize the value chain.
Lead business architecture portion of business blueprints, including establishing guiding principles, defining capabilities, performing functional analysis/definition, analyzing and documenting the value chain, and assessing organizational impacts.
Initiate enterprise‑wide functional analysis to identify areas for efficiencies or rationalization opportunities, and conduct ongoing analysis of business capabilities and how improvements to architecture components can best support capabilities.
Review a common process for how projects are assessed against business architecture artifacts and blueprints; incorporate into overall 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 equally effectively with many constituents, including business executives, technologists, end users, and operations.
Minimum Requirements Requires a BA/BS degree in Information Technology, Computer Science or related field of study and a minimum of 7 years experience in business analysis and strategic planning, IT operations, IT planning, IT leadership, or strategic and technical architecture; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities, And Experiences
Prior Elevance Health experience strongly preferred.
Prefer system knowledge: EDI/EDINET; SQL; JIRA; FACETS (CENTRAL/GBD); BlueSquare, WEBSTRAT; Authorization Overwrite Tool (AO Tool) .Net UI; Claims Workstation Pega UI.
Strongly prefer knowledge of claims process and data: Claims Train data, CAST Train data; CAST Lights On mgmt.; E2E claim lifecycle vetting; FICR; MGCT# Post adjudication; CPEC-Claims Payment Extract and Capitation; CIFT, CFE; GBD IT Pre/Post‑Adjudication; COPS; UM MATCH LOGIC; PROVIDER/PRICING CONFIG utilization.
Experience in health care industry strongly preferred.
Enterprise Architecture related certifications strongly preferred.
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 one day 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.
Elevance Health’s National Operations Command Center (NOCC)
is responsible for end‑to‑end monitoring of operational, experience and financial performance across enterprise functions, proactively identifying and permanently solving issues with deep root‑cause data analysis.
How You Will Make An Impact
Support cost‑of‑care and other provider‑based root‑cause investigations leveraging intimate provider system and business process knowledge to audit system configuration and end‑to‑end inventory lifecycle for potential errors.
Conduct sophisticated data & analytics reports and synthesize findings on root‑cause contributors and organizational and/or stakeholder experience impact.
Based on system root‑cause findings, recommend process and system enhancements to permanently solve identified issues, converting business requirements into technical requirements and managing the handoff to technology implementation teams.
Provide linkages to other Enterprise Architecture groups and models, coordinate and align activities to achieve the 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) that articulate a future state direction to optimize the value chain.
Lead business architecture portion of business blueprints, including establishing guiding principles, defining capabilities, performing functional analysis/definition, analyzing and documenting the value chain, and assessing organizational impacts.
Initiate enterprise‑wide functional analysis to identify areas for efficiencies or rationalization opportunities, and conduct ongoing analysis of business capabilities and how improvements to architecture components can best support capabilities.
Review a common process for how projects are assessed against business architecture artifacts and blueprints; incorporate into overall 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 equally effectively with many constituents, including business executives, technologists, end users, and operations.
Minimum Requirements Requires a BA/BS degree in Information Technology, Computer Science or related field of study and a minimum of 7 years experience in business analysis and strategic planning, IT operations, IT planning, IT leadership, or strategic and technical architecture; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities, And Experiences
Prior Elevance Health experience strongly preferred.
Prefer system knowledge: EDI/EDINET; SQL; JIRA; FACETS (CENTRAL/GBD); BlueSquare, WEBSTRAT; Authorization Overwrite Tool (AO Tool) .Net UI; Claims Workstation Pega UI.
Strongly prefer knowledge of claims process and data: Claims Train data, CAST Train data; CAST Lights On mgmt.; E2E claim lifecycle vetting; FICR; MGCT# Post adjudication; CPEC-Claims Payment Extract and Capitation; CIFT, CFE; GBD IT Pre/Post‑Adjudication; COPS; UM MATCH LOGIC; PROVIDER/PRICING CONFIG utilization.
Experience in health care industry strongly preferred.
Enterprise Architecture related certifications strongly preferred.
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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