Business Consultant – Carelon Payment Integrity
Elevance Health
full-time
Posted on:
Location Type: Hybrid
Location: Atlanta • Florida • Kentucky • United States
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About the role
- 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
Requirements
- Requires a BA/BS and minimum of 8 years business analysis experience
- 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
- Advanced MS Excel capabilities required (pivot tables, VLOOKUP, formulas)
- 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
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical benefits
- dental insurance
- vision insurance
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
business analysisclaims processingcoding practicesreimbursement policiespayer-provider contractingadvanced MS Excelpivot tablesVLOOKUPformulas
Soft skills
leadershipcommunicationconsultationproblem-solvingstakeholder alignmentproject management
Certifications
BA/BSCPC