AddressDescription
Business Analyst II
Location : This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.
The BUSINESS ANALYST II is responsible for identifying, analyzing, and validating overpayment recovery opportunities, translating moderately complex and varied business needs into business cases or business requirements document (BRD) to create data mining queries that will contribute to cost of care savings.
How you will make an impact:
- Analyzes business needs to determine optimal means of meeting those needs.
- Assessing overpayment opportunity by reviewing low to high volume claim samples.
- Accessing provider contracts, company claims policy and coding guidelines to support recovery opportunity.
- Works with programming staff to ensure requirements will be incorporated into concept design and testing of claims identified as potential overpayments.
- Collaborating with Query Developers, business owners and Business Consultants.
- Collaborates with the claims validation team to approve concepts for recovery.
- Identify process improvement opportunities that result in increased savings.
- Consults with business partners concerning processes, procedures, contracts, processing rules and other system rules to identify overpayments.
- Obtains, interprets, and applies provider and member contract language to the creation of BRDs (business requirement documents) that contribute to CoC.
Minimum Requirements:
- Requires a BA/BS and minimum of 3 years related business analysis experience, or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences :
- WGS claims processing/adjusting experience strongly preferred.
- Project management and MS Excel experience preferred.
- Ability to manage multiple projects in various stages to completion preferred.
- In-depth knowledge of claims processing, reimbursement policies and procedures strongly preferred.
- Strong analytical and problem-solving skills with research-oriented approach preferred.
- Strong written, verbal, and interpersonal communication skills preferred.
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $60,984 to $104,544
.
Locations: Colorado & Nevada
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 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 .
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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
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. 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 elevancehealthjobssupport@elevancehealth.comfor assistance.
