Business Analyst II- Data Mining Overpayment and Operations/Payment Integrity-WGS Commercial Claims

Analyzing Claims Data

The Business Analyst II analyzes claims data and contract/policy guidelines to identify and assess overpayment and prevention opportunities. This includes researching leads and evaluating complex scenarios.

Translating Needs into Requirements

Translates business needs into clear requirements for prepayment solutions, collaborating with data analysts on query design, testing (UAT), and implementation.

Improving Processes and Efficiency

Prioritizes and manages work while identifying process improvements that drive increased savings and operational efficiency.

Determining Application Software Requirements

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.

Liaison Role

Acts as liaison with users of the software to address questions/issues.

Qualifications

• 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.
• In-depth knowledge of WGS / CI&W Commercial Claims processing or adjustments is preferred.
• In-depth knowledge of WGS Pricing Arrangements for East Region - CT, ME, NH, GA, NY, VA commercial markets.
• Reimbursement Policies, Provider Contract, and Member Benefit expertise – highly preferred.

Preferred Skills and Capabilities

• Strong oral, written, and interpersonal communication skills.
• Problem-solving skills.
• Facilitation skills.
• Analytical skills.
• Project management.
• Ability to manage multiple projects in various stages to completion.
• Fully fluent in MS Excel.

Benefits

Includes 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

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.

Culture

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.

Workplace

We operate in a Hybrid Workforce Strategy. 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.

COVID-19 Vaccination Requirement

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. Applicants required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.