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

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. 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.

About the role

As a part of the Data Mining Overpayment and Operations team, the Business Analyst III is responsible for serving as the liaison between business and IT in translating complex business needs into business cases or business requirements documents (BRD) to create machine learning models or data mining queries that will contribute to cost of care savings. How You Will Make An Impact

• Analyzes complex claims data including identifying trends, overpayment risks, and opportunities for prevention.
• Identifies areas at risk and make recommendations on how to minimize the risk.
• Consults with business partners concerning processes, procedures, contracts, processing rules and other system rules.
• Performs analysis of structured and unstructured data to identify trends, solve complex business problems, and support overpayment detection using automation/AI tools.
• Collaborates with cross-functional teams to identify process gaps and recommend solutions that minimize risk and improve overpayment prevention and recovery outcomes.
• Works with business partners to ensure solutions are in place for leakage around automation and testing to validate potential overpayments.
• Acts as a resource and consultant to users and business partners, addressing questions related to systems, processes, procedures, and implementation of technology.
• May provide direction and guidance to team members, lead efforts on complex projects, and serve as a subject matter expert for the team.

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. Knowledge of systems capabilities and business operations is strongly preferred.

Preferred Skills, Capabilities And Experiences

Knowledge of systems capabilities and business operations is strongly preferred. Experience in payment integrity or recovery operations, including leakage analysis. Knowledge of WGS, pricing outcomes, and recovery/concept tools (e.g., PICM, ECM, ACR). Strong data analysis skills with ability to quantify trends and financial impact. Advanced Excel skills (pivots, formulas, VLOOKUPs, Power Query). Ability to communicate insights and partner to resolve process and automation gaps. Claims processing skills

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.

Benefits

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.

Work Schedule

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.

COVID-19 Vaccination Requirement

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. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and 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. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.

Equal Employment Opportunity

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.