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　　Claim Validation Analyst III - Payment Integrity

　　Job Family: Business Support

　　Type: Full time

　　Date Posted:Jan 24, 2024

　　Anticipated End Date:Jan 31, 2024

　　Reference: JR103113

　　Location:

　　GA, ATLANTA

　　PA, SEVEN FIELDS

　　CA, WOODLAND HILLS

　　MO, ST LOUIS

　　FL, MIAMI

　　IN, INDIANAPOLIS

　　OH, MASON

　　IL, CHICAGO

　　NH, MANCHESTER

　　ME, SOUTH PORTLAND

　　FL, TAMPA

　　NY, MIDDLETOWN

　　GA, MIDLAND

　　KS, TOPEKA

　　NV, LAS VEGAS

　　MN, MENDOTA HEIGHTS

　　VA, NORFOLK

　　Description

　　Claims Validation Analyst III (Business Analyst III)

　　Location: This position will work on a hybrid model (1-2 times per week in the office). The ideal candidate will live within 50 miles of one of our office locations.

　　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.

　　Come join our Carelon Payment Integrity’s Claims Anomaly Detection Team. The Claims Validation Analyst III (Business Analyst III) will be data mining, finding anomalies, and validating our findings for external clients. We’re looking for candidates with a claims background, (coding, keying claims, processing, adjusting, any combo of experience) who can research and data mine, detecting claims issues tied to coding inconsistencies, provider contracting, pricing, and reimbursement policies. Good communication, both written and verbal is important as we will be working directly with our clients.

　　Responsibilities

　　How you will make a difference:

　　Participate as a liaison between the business, business partners, and external clients.

　　Translate multifaceted business needs and requirements into specific and complex applications.

　　Conduct concept validation with the ability to analyze large data sets to be able to trend and research anomalies.

　　Ability to investigate, research, and adhere to medical coding guidelines.

　　Maintain awareness of variances in medical policies that may apply to concept execution and design.

　　Work frequently with business partners and external clients to develop, maintain, improve, and enhance business requirements.

　　Effectively research leads and identify ideas for additional overpayment opportunities.

　　Act as a resource for business partners and external clients to address any issues, concerns, discrepancies, questions, and ability to provide support or SME for the team.

　　Ability to follow procedures and be able to document client-specific processes and procedures.

　　Facilitate meetings and coordinate appropriately with business partners and external clients.

　　Ability to manage and prioritize work assignments and projects based on business needs.

　　Uphold high standards with sensitive data handling and client confidentiality.

　　Contribute to team growth with innovation and agility.

　　Adhere to team and role expectations.

　　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 Qualifications, Skills, and Experiences:

　　Advanced skill level with MS Excel, pivot tables, formulas, V-lookup, etc.

　　Must possess strong analytical and problem-solving skills with a research-oriented approach; strong written, verbal, and interpersonal communication skills are required.

　　Claims Experience to include any combination of the following: claims processing, adjustments, recovery, disputes, Government or Commercial business

　　For candidates working in person or remotely in the below locations, the salary* range for this specific position is $68,080 to $122,544.

　　Locations: California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJ

　　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 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. 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 [email protected] for assistance.

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　　Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.

　　EEO Policy Statement

　　Know Your Rights

　　Pay Transparency

　　Privacy Notice for California Residents

　　Elevance Health, Inc. is anE-verify Employer (https://www.e-verify.gov/sites/default/files/everify/posters/EVerifyParticipationPoster.pdf)

　　Need Assistance?

　　Email us ([email protected])