Business Analyst II

Anticipated End Date:

2025-07-15

Position Title:

Business Analyst II

Job Description:

Business Analyst ll

Hybrid 1: This role requires associates to be in-office in office once per week (Must be able to work until 4pm MST) 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.

The BUSINESS ANALYST II Identifies, analyzes, and validates overpayment recovery opportunities. Determines specific business requirements to address complex business needs. Works with Query Developers to ensure business requirements are incorporated into query design, completes and coordinates UAT testing on claims identified as potential overpayments. 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:

• 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.
• Interacting with query developers, business owners, and business consultants.
• Manage and prioritize work assignments based on business needs.
• Effectively research leads to identify additional recovery savings opportunities.
• Identifies and analyzes complex overpayment recovery needs to determine optimal means of meeting those needs.
• Determines specific business requirements to address complex business needs.
• Develops Business Requirement Documentation and coordinates UAT, involving those outside the unit.
• Identify process improvement opportunities that result in increased savings.
• Serve as a liaison between the data science, recovery adjustments and other business partners.
• Consults with business partners concerning processes, procedures, contracts, processing rules and other system rules to identify overpayments.
• Analyzes and designs solutions to address complex and varied business needs.
• Obtains, interprets, and applies provider and member contract language to the creation of BRDs that contribute to CoC.
• Consults with business partners concerning application and implementation of technology.
• Writes Business Requirement Documents (BRD) and demonstrated experience and ability to perform UAT for low to high complexity projects.
• Provide direction and guidance to analysts and serves as an expert for the team.
• Responsible for translating the most highly complex and varied business needs into BRD requirements for query builds. 

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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 required.
• In-depth knowledge of WGS Pricing Arrangements for the West Region (CA, CO and NV)
• 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 virtually in the below location(s), the salary* range for this specific position is $59,920 to $103,362

Locations: California, Colorado, 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 He