Business Analyst III - Carelon Payment Integrity

Business Analyst III

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. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending.

The Business Analyst III is a member of our Carelon Payment Integrity's Data Mining Team , where we utilize advanced analytics to uncover anomalies and drive real savings. This position plays a critical role in uncovering claims overpayments and guiding clients through implementation of data-driven insights. This individual will be data mining, finding anomalies and validating our findings for external clients.

How you will make an impact:

• Analyzes complex end user needs to determine optimal means of meeting those needs.

• Determines specific business application software requirements to address complex business needs.

• Develops project plans and identifies and coordinates resources, involving those outside the unit.

• Works with programming staff to ensure requirements will be incorporated into system design and testing.

• Acts as a resource to users of the software to address questions/issues.

• May provide direction and guidance to team members and serves as an expert for the team.

• Validates findings and presents results to team leads for informed decision-making.

• Serves as a key liaison between business consultants, data analysts, query developers, and project teams or clients if applicable, ensuring seamless communication and coordination.

• Conducts root-cause analysis and identifies patterns in large data sets to drive efficiency.

• Researches and trends claim anomalies to enhance process accuracy.

• Manages multiple projects simultaneously, meeting deadlines and business needs efficiently.

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.

Preferred Skills, Capabilities and Experiences:

• Prior experience in health insurance claims processing (e.g., coding, keying, adjusting) highly preferred.

• Advanced MS Excel skills (pivot tables, VLOOKUP, formulas) highly preferred.

• Strong analytical and research orientation with a knack for solving problems preferred.

• Excellent communication (both written and verbal) and interpersonal skills preferred

• Proven ability to collaborate across departments preferred.

• Ability to work independently in a dynamic environment and collaboratively preferred.

• Coding certification (e.g., CPC) preferred.

• Experience with client/vendor relations, customer service, or healthcare analytics a plus.

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 may contact for assistance.

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.