Business Analyst III
Location: All locations to be considered.
Schedule: Flex 1 (0-3 days in offer per month)
This is an opportunity to join a growing team of associates within DBG (Diversified Business Group). Our team is responsible for identifying claims processing issues on WGS through data mining and then creating business requirements documents (BRD) to assist with creation of algorithms that will contribute to cost of care savings and total program savings. These positions will primarily perform WGS tasks in conjunction with the pre-pay initiative project for Datamining and Overpayments (DMO).
How you will make an Impact;
- Analyzes and designs solutions to address simple to complex varied business needs by utilizing specific business application software requirements.
- Researches leads to identify overpayment savings opportunities on claims processing in WGS Mainframe.
- Obtains, interprets, and applies provider and member contract language to the creation of BRDs that contribute to the department’s Cost of Care (CoC) savings goal.
- Determines specific business requirements to address simple to complex potential overpayment situations based on analysis of claims, policies, and other supporting documentation.
- Consults with business partners concerning processes, procedures, contracts, processing rules and other system rules to create concepts to identify overpayments.
- Develops and maintains collaborative relationships with query developers, business owners and partners as well as DBG consultants and analysts to ensure requirements will be incorporated into system design and testing.
- Develops Business Requirement Documentation (BRD) and completes UAT and coordinates PNP (process and procedure) documentation, involving those in and outside the business unit.
- Collaborates, provides guidance to team members, and serves as a resource for the team.
- Acts as a Subject Matter Expert (SME) on projects and in meetings with team and business partners.
- Identifies process improvement opportunities that result in increased savings.
- Manages and prioritizes own work based on business needs.
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.
Preferred Skills, Capabilities and Experiences:
- Commercial Business (WGS) knowledge, including claims and adjustment processing.
- Knowledge in WGS pricing, including reading and interpreting provider contracts and rate sheets.
- Strong oral, written, organizational skills and interpersonal communication skills.
- Demonstrated leadership experience.
- Possess analytical and problem-solving skills with research-oriented approach.
- Ability to manage multiple projects in various stages and complexity levels to completion.
- Demonstrated meeting facilitation skills.
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $66,720 to $115,092
Locations: California, Colorado; Nevada, Washington State, Jersey City, NJ; New York City, NY; Ithaca, NY and Westchester County, NY
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws .
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
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.
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. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. 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 may contact firstname.lastname@example.org for assistance.