Job Description
Business Consultant
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. 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 Consultant is a member of our
Carelon Payment Integrity’s Data Mining Team , where we utilize advanced analytics to uncover anomalies and drive real savings. This position plays a critical role in uncovering claims overpayments and guiding clients through implementation of data-driven insights. This individual will be data mining, finding anomalies and validating our findings for external clients.
How You Will Make An Impact - 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.
- Lead client consultations to identify and resolve payment integrity issues.
- Analyze complex claim scenarios and business rules to uncover overpayments.
- Guide cross-functional teams through the development and implementation of recovery strategies.
- Design business solutions to address diverse client requirements.
- Partner with query developers to refine logic based on client data and operational feedback.
- Facilitate internal and external meetings, ensuring alignment across stakeholders.
- Document findings, track projects, and manage timelines to successful delivery.
Minimum Requirements 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 - Prior experience in healthcare claims, payment integrity, or consulting highly preferred.
- Strong understanding of claims processing, coding practices, reimbursement policies, and payer-provider contracting preferred.
- Demonstrated ability to work directly with clients and build long-term relationships preferred.
- Advanced MS Excel capabilities required (pivot tables, VLOOKUP, formulas) highly preferred.
- Experience leading projects and managing cross-functional stakeholders preferred.
- Coding certification (e.g., CPC) is strongly preferred.
- Strong verbal and written communication skills are highly preferred.
- Ability to translate technical findings into actionable business strategies preferred.
- Experience with client/vendor relations, customer service, or healthcare analytics a plus.
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.
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 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.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Job Tags
Temporary work, Full time, Work at office, Local area, 1 day per week, 2 days per week,