Business Analyst II

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Job Description:

Business Analyst II

Alternate locations may be considered. This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our PulsePoint locations. Must be able to work until 4pm MST

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 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:

• 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.
• Assessing overpayment opportunity by reviewing low to high volume claim samples.
• Accessing provider contracts, company claims policy and coding guidelines to support recovery opportunity.
• Partnering closely with recovery data analysists to create queries that will identify overpayment identifications for recovery.  
• Works with Query Developers to ensure requirements will be incorporated into recovery query design and testing.
• Assessing overpayment opportunity by reviewing low to high volume claim samples.
• Accessing provider contracts, company claims policy and coding guidelines to support recovery opportunity.
• Partnering closely with recovery data analysists to create queries that will identify overpayment identifications for recovery. 
• Develops Business Requirement Documentation and coordinates UAT, involving those outside the unit.
• Identify process improvement opportunities that result in increased savings.
• Consults with business partners concerning processes, procedures, contracts, processing rules and other system rules to identify overpayments.
• Writes Business Requirement Documents (BRD) and demonstrated experience and ability to perform UAT for low to high complexity projects.
• Responsible for translating the most highly complex and varied business needs into BRD requirements for query builds. 

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 Commercial Claims processing or adjustments is preferred.
• In-depth knowledge of WGS Pricing Arrangements for West Region - CA, CO, NV commercial markets.
• Reimbsusment 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.

For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $59,920 to $107,856

Locations: California, Colorado; Nevada, New York

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.

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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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

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 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, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.