Elevance Health

Machine Learning Engineer

• Design, develop, and deploy AI/ML and Generative AI solutions that address business and operational challenges at enterprise scale.
• Build and maintain infrastructure, pipelines, and services that connect structured and unstructured data sources for AI-driven applications.
• Develop reusable AI capabilities including RAG pipelines, vector search, semantic retrieval, prompt orchestration, and agentic workflows.
• Implement evaluation frameworks and automated testing strategies to measure model quality, accuracy, bias, safety, and performance.
• Establish monitoring, observability, and governance processes to ensure AI systems remain reliable and compliant in production.
• Collaborate with engineering and product teams to integrate AI capabilities into enterprise platforms and applications.
• Drive adoption of Responsible AI practices by implementing evaluation standards, audit-ready documentation, and model governance controls.
• Optimize AI systems for scalability, latency, reliability, and cost efficiency.
• Support experimentation, benchmarking, and model comparison activities to improve decision-making and accelerate AI innovation.
• Partner with cross-functional stakeholders to translate business requirements into production-ready AI capabilities and services.
• Contribute to technical standards, architecture decisions, and best practices for enterprise AI engineering.
• Develop experimental and analytic plans for machine learning algorithms and data modeling processes, use of strong baselines, and ability to accurately determine cause and effect relations.

AI Machine Learning Scientist

Research Scientist

• Responsible for leadership in assessing scientific research contributing to the transformation of health outcomes research
• Focus on design, development, evaluation, and deployment of advanced machine learning systems
• Publish findings and conclusions in recognized scientific publications
• Lead research project operations activities including project conceptualization, planning, leading project teams, and proposal defense presentations
• Ensure quality and timeliness of deliverables to research clients

Senior Research Scientist

Compliance

• Directs projects, initiatives, regulatory sanctions, executive-sponsored initiatives, regulatory audits or exams, internal audits, accreditations, on-site reviews, risk assessments
• Leads compliance monitoring to identify process gaps, validate compliance levels, map processes, draft corrective actions/remediation plans
• Leads complex investigations and documents findings
• Develops strategic plans, makes recommendations to leadership; designs/implements annual compliance plan
• Develop strong relationships with key leaders to identify and address compliance risks and failures

Compliance Director – Clinical Regulatory Focus

Manager

• manage the full lifecycle of Carelon Health client contracts
• oversee contracting workflows
• ensure compliance with policies and regulations
• evaluate contracts for adherence to standard terms
• make suggested contract edits for attorney review
• implement technology for contract lifecycle management
• collaborate with internal and external stakeholders
• maintain and update contract templates

Contract Manager

Data Entry

• Verifies member information and inputs data for the pharmacists
• Educates members on pharmacy-based rules related to prescriptions and medication resources or assistance programs
• Contact medical doctor offices to obtain missing information pertinent to the prescription
• Collaborate with other departments to prioritize patient care and satisfaction
• Responds to inquiries from physicians, sales team, and members related to formulary and prescription benefits
• Maintains record keeping of prior authorizations, rebates, and monthly reports

Pharmacy Technician I, Data Entry

General Counsel

• Leads legal strategy and support for Medicaid State Fair Hearing matters
• Advises internal business partners on federal and state Medicaid hearing requirements
• Coordinates with and oversees outside counsel to ensure appropriate staffing
• Represents the organization in legal duties associated with serving as legal counsel for Medicaid markets
• Develops recommendations and solutions that are thorough, practical and consistent with organizational objectives

Senior Legal Counsel – Medicaid

Analyst

• Reviews and evaluates accident or incident reports, individual claims, medical, legal or other documents relating to subrogation.
• Responds to inquiries regarding claim recovery issues.
• Identify, monitor and evaluate claim data to determine relatedness and reimbursement amounts.
• Analyze, interpret and apply plan language, contracts, case law and various statutes or regulations.
• Prepares and maintains case files, correspondence, legal documents and other information related to subrogation claims.
• Coordinates actions involving accounting for payments received.
• Evaluates and negotiates settlements of subrogation claims of all dollar amounts within a prescribed level of authority.

Subrogation Analyst

Sales

• Develops strategies and utilizes selling techniques to acquire new business sales (medical, wellness and specialty products) by managing pipeline and achieving results through sales process for national accounts.
• Generates lead activity and makes sales calls.
• Leverages understanding of the consultant (AON, Mercer, WTW) community and/or national account space to produce sales.
• Manages projects and meets with key stakeholders to determine scope and deliverables.
• Participates in and utilizes market knowledge in the request for proposal (RFP) production including geo access and disruption reporting.
• Develops and maintains consultant, broker and/or customer relationships.
• Travels to worksite and other locations as necessary.

National Sales & Retention Executive

• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
• Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
• Coordinates internal and external resources to meet identified needs.
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
• Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
• Negotiates rates of reimbursement, as applicable.
• Assists in problem solving with providers, claims or service issues.

Nurse Case Manager I

• Provides strategic planning and account management for large accounts
• Directs and manages the administration of contractual requirements and obligations
• Manages the new and renewal implementation process for accounts
• Interfaces with operations to ensure smooth delivery of services
• Maintains ongoing account relationships at multiple levels throughout the customer's organization
• Makes recommendations for improvements to meet customers' expectations
• Develops implementation processes and manages reporting processes to ensure client retention and high levels of account satisfaction
• Provides both on-site and off-site account management
• Presents monthly, ad hoc, mid-year, and annual utilization and benefit reporting to the broker and client
• Coordinates open enrollment meetings, renewal process and training sessions
• Participates in efforts to support standardization across accounts and works in multi-disciplinary teams to design and implement product and operational enhancements
• Provides guidance or expertise to less experienced account service managers
• Makes routine account visits

Senior Account Service Manager

Operations

• Acts as a strategic advisor and operational partner to the President
• Provides executive-level support in the planning, coordination, and execution of critical business priorities
• Leads and oversees complex, cross-functional initiatives, enterprise programs, and strategic projects
• Identifies potential issues, project charge, and scope
• Leads efforts to identify best practices
• Identifies impacted parties, business partners, and resources required
• Develops and designs processes and systems that support business needs
• Designs methods for integrating function and process
• Conducts cost/benefit analyses
• Builds support for business change throughout the business unit
• Develops executive level presentations

Business Change Manager – Executive Operations, Execution

Director

• Actively leading, directing, coordinating and providing visibility into engagement, communications, and training efforts for enterprise transformation initiatives.
• Creates and executes change management strategies, developing change that maximizes stakeholder change readiness and adoption of strategies to support delivering identified project benefits.
• Executes strategic interventions to support clarity, understanding, alignment, and sustainment of programmatic changes.
• Applies structured change management methodology to facilitate change and promote adoption of the change.
• Prepares for change by assessing the magnitude and risk of change with the organization’s change readiness.
• Identifies pitfalls and potential points of challenge or change aversion.
• Conducts thorough methodological investigations to identify key internal and external stakeholders impacted by the change and determines appropriate timing of that change.
• Conducts an environment scan to identify potential challenges for stakeholders.
• Modifies change management plans to accommodate the needs of the various impacted stakeholder groups.
• Creates engagement and communications strategies/plans to ensure all stakeholders are fully aware of impending changes.
• Works with appropriate departments to create coaching plans for enterprise leaders and associates and other key stakeholders.
• Conducts an impact assessment for stakeholders affected by the change items.
• Regularly reviews and assesses potential change fatigue across all stakeholders and provides recommendations to address.
• Performs quantitative and qualitative assessment of change success and change adoption.
• Solicits feedback from stakeholders to determine the success of change management activities and ensure that behavioral changes align with strategic objectives.
• Works collaboratively with Communications/PR, Associate Experience & Listening, Human Resources, Legal, Public Affairs and Compliance and Enterprise Transformation leaders at all levels to ensure integration and alignment of business plans.
• Councils project teams, business partners and others in the organization in change management practices to increase effectiveness in driving sustainable change.
• Mentor emerging change management talent across enterprise and team.

Enterprise Change Management Director

Call Center Representative

• identify, track, and reconcile overpayments made to providers
• ensure that recovery is made and reported under general supervision
• perform all authorized duties in the processing of overpayments
• provide exceptional service to members, providers, group administrators, and attorneys
• manage high-volume intake calls and correspondence inventory effectively
• determine membership eligibility using various job aids and membership systems
• respond to calls, letters, faxes, and emails from policyholders, agents, vendors, and/or providers
• develop relationships with other business units and service partners
• adhere to company and department policies and procedures as well as HIPAA regulations

Recovery Specialist Associate – Call Center

Account Executive

• Serve as the primary clinical pharmacy consultant for assigned commercial employer group clients, providing strategic guidance on pharmacy benefit performance, utilization trends, emerging therapies, and cost-management opportunities.
• Partner closely with account management, sales, consultants, and brokers to support client relationships, deliver pharmacy benefit insights, and communicate the value of PBM programs and clinical solutions.
• Develop and deliver client-facing presentations, annual reviews, pharmacy trend updates, and strategic recommendations to employer groups, consultants, and broker partners.
• Provide ongoing clinical support to regional decision makers and support PBM field sales teams during RFP processes, finalist presentations, and client consultations.
• Analyze pharmacy utilization data and assist in the development of recommendations for outcomes-based savings opportunities, trend management strategies, and clinical program enhancements.
• Collaborate with internal business partners to evaluate and support therapeutic programs, utilization management initiatives, and pharmacy solutions that improve client outcomes and financial performance.
• Respond to client and internal stakeholder inquiries regarding pharmacy benefits, formulary strategy, specialty pharmacy management, and clinical program performance.
• Support internal health plan penetration, retention, and growth objectives through strong consultative relationships and clinical expertise.

Pharmacy Account Director – Commercial Employer Group

Consultant

• Focus on chart reviews by supplying clinical expertise to ensure full accurate and appropriate diagnosis, documentation, coding and care
• Review provider visit medical encounters and apply appropriate diagnosis codes
• Overall accountability for HCC/Risk Adjustment goals and workflows to support value capture initiatives and high-quality clinical documentation
• Chart reviews for closing HEDIS care opportunities
• Liaison to coding team
• Participate in peer review of medical documentation for completed visit notes and patient profile information in EMR
• Review and correct ICD-10 codes assigned in charts
• Provide feedback to providers for improved documentation to support specific codes