Business Claims Analyst II – Wellpoint Federal

Location: 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. Alternate locations may be considered. Candidates must be within a reasonable commuting distance from the posting location(s) unless an accommodation is granted as required by law.

About the Role

Wellpoint Federal, a subsidiary of Elevance Health, brings deep industry expertise and healthcare service capabilities to support federal programs. The organization delivers solutions across claims administration, data, and care delivery to help address complex challenges and improve health outcomes for federal populations.

This position is part of our Wellpoint Federal division which, per CMS TDL 190275, requires foreign national applicants meet the residency requirement of living in the United States at least three of the past five years.

How You Will Make an Impact

• 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

• BA/BS and minimum of 3 years related business analysis experience, or any combination of education and experience, which would provide an equivalent background.
• Minimum of two (2) years of experience working within a Claims Operations environment highly preferred.
• Prior experience supporting Medicare Fee-for-Service (FFS) claims processing strongly preferred.
• Demonstrated understanding of Part A and/or Part B claims workflows, including regulatory requirements, CMS guidance, and CR/TDL implementation processes.
• Experience responding to external audits, CMS inquiries, compliance requests, and cross-functional operational initiatives.
• Proven ability to identify process improvement opportunities and drive standardization across teams.
• Experience developing or maintaining SOPs, job aids, and centralized documentation repositories.
• Strong collaboration skills with the ability to work across operational areas (e.g., Clinical Claims, Appeals, Provider Enrollment, EDI, Contact Centers, and other business partners).
• Ability to analyze operational trends, recommend solutions, and support innovation initiatives within a regulated environment.
• Comfortable working with data (Excel, basic SQL is a plus) and using tools like Power BI to review and share insights.
• Foundational understanding of AI capabilities in healthcare and how they can support process improvement or reduce manual work.

If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a 'sensitive position' work designation and may be subject to additional requirements including more stringent background checks, government clearances, segregation of duties principles, role-specific training, and sensitive data handling instructions.

Pay

For candidates working in person or virtually in Maine, New York, or Virginia, the salary range for this specific position is $61,680 to $92,520. The salary offered is based on a number of legitimate, non-discriminatory factors set by the Company.

Benefits

In addition to your salary, Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements). Benefits include:

• Medical, dental, and vision coverage
• Short and long-term disability benefits
• 401(k) with company match
• Stock purchase plan
• Life insurance
• Paid holidays and Paid Time Off (PTO)
• Wellness programs and financial education resources
• Incentive bonus programs

Schedule

Elevance Health operates 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.