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

Anticipated End Date:

Position Title:

Job Description:

Business Analyst II – Commercial Claims Data Mining

Shift: Monday – Friday

The Business Analyst II is responsible for translating basic business needs into application software requirements. Identifies, analyzes, and validates overpayment recovery opportunities. Determines specific business requirements to address complex business needs. Completes all required documentation to support workflow and reporting.  Collaborates with the claims validation team to approve concepts for recovery. May provide direction and guidance to team members.

How you will make an impact:

• Analyze claims data and contract/policy guidelines to identify and assess overpayment and prevention opportunities, including researching leads and evaluating complex scenarios.

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

• Prioritize and manage work while identifying process improvements that drive increased savings and operational efficiency.

• 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. 

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:

• 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

• Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

• Project management, ability to manage multiple projects in various stages to completion.

• Fluent in MS Excel.

Job Level:

Workshift:

Job Family:

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.

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 and Influenza. 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 should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

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

NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13.