Business Analyst II

Anticipated End Date:

2025-07-23

Position Title:

Business Analyst II

Job Description:

Business Analyst II - Commercial Claims Data Mining

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.

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.

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 opportunities 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 opportunities by reviewing low to high volume claim samples.
• Accessing provider contracts, company claims policy and coding guidelines to support recovery opportunity.
• Partnering closely with query 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 / CI&W Commercial Claims processing or adjustments is preferred.
• In-depth knowledge of WGS Pricing Arrangements for East Region - CT, ME, NH, GA, NY, VA commercial markets. .
• Reimbursement 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 virtually in the below location(s), the salary* range for this specific position is $59,920t o $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 th