Director, Enterprise Reimbursement Strategy

Elevance Health

Director overseeing Cost of Care Ideation for Elevance Health contracts with focus on services managed by Carelon Health. Leading cross-functional collaboration and project management to develop strategic initiatives.

Posted 8/3/2026full-timeAtlanta • Ohio • 🇺🇸 United StatesLeadWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in strategic initiatives for controlling medical costs, with a strong focus on CMS reimbursement guidelines and managed care payment systems. Proven ability to lead teams, manage projects, and develop innovative reimbursement methodologies.

Highest-signal resume keywords

Strategic Initiative DevelopmentCMS Payment Methodology ApplicationProject ManagementManaged Care Provider KnowledgeFinancial/Economic Business Modeling

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Financial ModelingReimbursement MethodologiesClaims Payment SystemsCost Control StrategiesData Analysis

Soft Skills

Team LeadershipCommunicationCoachingPerformance EvaluationCollaboration

Certifications & Qualifications

CPAMBA

Industry Keywords

Managed CareHealthcare AdministrationProvider SolutionsCMS Reimbursement GuidelinesWorkflow Coordination

About the role

Key responsibilities & impact

Development and implementation of strategic initiatives to control unit medical costs.
Evaluation of annual CMS reimbursement guidelines and recommendations as they relate to control over medical claims cost.
Research and develop new contracting and reimbursement methodologies.
Facilitates the communication of activities, emerging trends, and best practices with provider solution leadership across all lines of business.
Directs the daily interaction with and requests for reimbursement subject matter expertise and support.
Oversee and prioritize workflow.
Coordinates with Reimbursement Policy/Edit team as necessary to achieve strategic reimbursement related goals.
Works closely with CoC team on PADU (Preferred/Acceptable/Discouraged/Unacceptable).
Hires, trains, coaches, counsels, and evaluates the performance of direct reports.

Requirements

What you’ll need

Requires a BA/BS degree in Business, Finance, Economics, or Healthcare Administration
a minimum of 10 years of related experience in broad-based, analytically oriented, managed care payor or provider environment required
Experience must include project management, CMS payment methodology application, and financial/economic business modeling
Advanced knowledge of managed care provider and claims payment systems and process is essential and strongly preferred
CPA, MBA or other equivalent advanced degree is preferred

Benefits

Comp & perks

merit increases
paid holidays
Paid Time Off
incentive bonus programs
medical, dental, vision
short and long term disability benefits
401(k) +match
stock purchase plan
life insurance
wellness programs
financial education resources