Business Consultant - Data Mining Overpayment...

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.

Shift: Monday - Friday 8:30AM - 5:30PM EST

Build the Possibilities. Make an Extraordinary Impact.

As a part of the Data Mining Overpayment and Operations team, the Business Consultant is responsible for translating moderately complex and varied business needs into application software requirements. Possesses full technical knowledge of most phases of systems and business analysis and is able to consider the business implications of the application of technology to current and future business environments..

How you will make an impact:

Primary duties may include, but are not limited to:

• May lead teams of analysts assigned to complex projects.

• Determines specific business application software requirements to address complex and varied business needs.

• Analyzes and designs solutions to address complex and varied business needs.

• Consults with business partners concerning application and implementation of technology.

• Analyze structured and unstructured data using automation/AI tools to identify trends, solve complex business problems, and uncover overpayment risks.

• Partner with business stakeholders to interpret processes, contracts, and system rules, ensuring accurate validation of claims and overpayments.

• Identify process and system risks, recommending and supporting automation and improvements to minimize risk and enhance outcomes.

• Requires a BA/BS and minimum of 8 years business analysis experience, which should include analysis and project management; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Knowledge of systems capabilities and business operations is strongly preferred.

• Deep expertise in claims processing, pricing, and overpayment analysis (WGS/CIW preferred).

• Strong leadership, mentorship, and facilitation experience.

• Ability to manage multiple priorities independently and drive results.

• Experience identifying new recovery opportunities and improving processes.

• Strong analytical and communication skills with stakeholder influence.

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.

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 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.