Business Analyst II – Payment Integrity Datamining

About

Carelon, a proud member of the Elevance Health family of companies, is a healthcare services organization that takes a whole-health approach to making care more integrated, personalized, and affordable. We put people at the center—connecting physical, behavioral, social, and pharmacy services, along with clinical expertise, research, operations, and advanced technology to help care work better, together.

Among us are care providers, engineers, data scientists, and other dedicated professionals determined to recover, eliminate and prevent unnecessary medical-expense spending.

Responsibilities

• Analyzes business needs to determine optimal means of meeting those needs
• Determines specific business application software requirements to address specific business needs
• Works with programming staff to ensure requirements will be incorporated into system design and testing
• Acts as liaison with users of the software to address questions/issues

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

• Familiarity with healthcare payer systems, claim lifecycle, and reimbursement methodologies, along with a basic understanding of medical billing guidelines and regulations.
• Exposure to medical coding systems (ICD, CPT, HCPCS) is a plus.
• Strong analytical abilities to review claim data and identify overpayment trends, along with a problem-solving mindset for troubleshooting issues and testing solutions.
• Ability to extract insights from data to support claim validation and recovery accuracy.
• Strong writing skills for provider communications and validation instructions, and the ability to create and maintain policies, manuals, and contracts to support transparency.
• Clear communication with stakeholders to address workflow inquiries.
• Capacity to adapt quickly to evolving tasks, new tools, and process improvements, with the ability to multitask.
• Self-starter, proactive in supporting recovery operations.
• Work effectively as a liaison between external business partners, vendors, and internal teams.
• Contribute to a culture of continuous improvement within Payment Integrity.
• Knowledge of systems capabilities and business operations is strongly preferred.

Additional Information

• Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
• For Government Business Division roles, additional requirements such as background checks, government clearances, and sensitive data handling apply.

Location and Work Policy

• 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.
• Candidates not within a reasonable commuting distance will not be considered unless accommodation is granted as required by law.

Compensation and Benefits

• Salary range: $64,764 to $97,146.
• Benefits include a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (subject to eligibility).

Company Overview

Elevance Health is a Fortune 25 health company dedicated to improving lives and communities and making healthcare simpler. We offer market-competitive total rewards including merit increases, paid holidays, Paid Time Off, incentive bonus programs, medical, dental, vision, disability benefits, 401(k) match, stock purchase plan, life insurance, wellness programs, and financial education resources.

Equal Opportunity

Elevance Health is an Equal Employment Opportunity employer and considers qualified applicants without regard to protected status. Accommodations are available for applicants during the job application process.