Business Analyst III - Payment Integrity Datamining

Anticipated End Date:

2026-01-30

Position Title:

Business Analyst III - Payment Integrity Datamining

Job Description:

Business Analyst III – Payment Intergrity Datamining

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 if candidates reside within a commuting distance from an office.

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 will be responsible for serving as the liaison between the business and IT in translating complex business needs into application software.

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
• Generate and refine creative recovery strategies that enhance our organization’s resilience through ideation of concepts, ensuring we are prepared and adaptable in the face of challenges.
• Work closely with subject matter experts to develop and prioritize business requirements, driving initiatives that align with our strategic goals and meet the needs of our stakeholders.
• Conduct thorough testing of processes and tools to ensure they meet high-quality standards and effectively support our business operations, contributing to overall efficiency and success.

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:

• Comprehensive understanding of healthcare payer systems, claims processes, and coding practices preferred.
• Demonstrated proficiency in analyzing complex data and creating clear, detailed documentation strongly preferred.
• Exceptional ability to communicate effectively with a variety of stakeholders, ensuring alignment and collaboration preferred.
• Proven track record of adapting to changing environments, effectively managing multiple tasks, and taking initiative preferred.
• Commitment to fostering a team environment characterized by transparency, adaptability, and a willingness to give and receive feedback desired.

If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a 'sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions.

Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions
Associates in these jobs must follow the specific policies, procedures, guidelines, etc
as stated by the Government Business Division in which they are employed.

Job Level:

Non-Management Exempt

Workshift:

1st Shift (United States of America)

Job Family:

BSP > Business Support

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