Elevance Health

Customer Support

• Identifies opportunities for engagement of members and their families in forming a supportive, recovery network
• Develops and implements provision of onsite psychiatric discharge planning education at Recovery and Resiliency sites
• Collaborates with Stabilization Teams as a member advocate in discharge planning education, resolution of barriers, and service transitions
• Acts as a resource for staff on decision making and problem solving
• Initiates and maintains contact with assigned individuals and providers to determine member’s response to services

Certified Peer Support Specialist

Consultant

• Develops and maintains positive provider relationships with provider community via a mixture of email, telephonic and/or face-to-face outreach
• Collaborates with internal matrix partners to triage issues and submit work requests
• Coordinates communication process on administrative and medical policy, reimbursement, and provider utilization patterns
• Conducts routine outreach to support the understanding of managed care policies and procedures
• Coordinates and conducts provider training including developing and distributing provider relations materials

Provider Relationship Account Consultant

Analyst

• Analyzing, reporting, and developing recommendations on data related to multiple, varied business metrics
• Creates and maintains databases to track business performance
• Analyzes data and summarizes performance using summary statistical procedures
• Develops and analyzes business performance reports and provides notations of performance deviations and anomalies
• Creates and publishes periodic reports, makes necessary recommendations, and develops ad hoc reports as needed
• May require taking business issues and devising the best way to develop appropriate diagnostic and/or tracking data

Business Information Analyst II – HEDIS Quality Analytics

• Analyzes data and summarizes performance using summary statistical procedures
• Develops and monitors testing use cases and analyzes results
• Develops ad hoc reports as needed
• Creates and documents business requirements
• Makes necessary recommendations
• Devises best way to develop appropriate diagnostic and/or tracking data that will translate business requirements into usable decision support tools

Business Information Analyst II

• Responds to customer questions via telephone regarding insurance benefits, provider contracts, eligibility and claims.
• Analyzes problems and provides information/solutions.
• Operates a PC/image station to obtain and extract information; documents information, activities and changes in the database.
• Thoroughly documents inquiry outcomes for accurate tracking and analysis.
• Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
• Researches and analyzes data to address operational challenges and customer service issues.
• Provides external and internal customers with requested information.
• Under immediate supervision, receives and places follow-up telephone calls / e-mails to answer customer questions that are routine in nature.

Customer Care Representative

Manager

• Develops the provider network through contract negotiations, relationship development, and servicing.
• Primary focus of this role is contracting and negotiating contract terms.
• Works with the most complex providers.
• Serves as key resource for other contracting staff and provides mentoring and on-the-job training and development.
• Works independently and requires high level of judgment and discretion.
• May work on projects impacting the business unit requiring collaboration with other key areas or serve on enterprise projects around network management.
• May collaborate with sales team in making presentations to employer groups.
• Serves as a communication link between professional providers and the company.
• Conducts more complex negotiations and drafts documents.
• Prepares financial projections and conduct analysis.

Senior Provider Network Manager

Compliance

• Directs projects, initiatives, regulatory sanctions, executive-sponsored initiatives
• Leads compliance monitoring to identify process gaps, validate compliance levels
• Leads complex investigations and documents findings
• Establishes and maintains effective compliance governance forums
• Develops strategic plans and makes recommendations to leadership

Compliance Director

General Counsel

• Provide legal advice and recommendations for initiatives and projects developed in response to clients overall objectives and needs
• Negotiate and manage client contracts
• Collaborate with multiple business partners and legal colleagues
• Train the businesses and other legal team members on best practices and policies
• Ensure that all client contracts clearly document key deal terms and adhere to applicable laws

Legal Counsel

• Serves as a subject matter expert in the administrative and operational processes
• Assists in problem solving complex issues and cases, such as provider calls, e-services, and authorization issues
• May answer calls from providers and members and responds to phone inquiries
• Oversees out of network and chart review administrative processes
• Works to streamline processes to ensure productivity and accuracy
• Collaborates with internal departments on special projects and reporting
• Hires, trains, coaches, counsels, and evaluates performance of direct reports

Associate Manager, Clinical Support

Business Analyst

• Analyzes business needs to determine optimal means of meeting those needs
• Determines specific business application software requirements
• Works with programming staff to ensure requirements will be incorporated into system design and testing
• Acts as liaison with users of the software to address questions/issues

Business Analyst II

Financial Planning and Analysis

• Analyzing data and providing new processes, system enhancements and technical solutions to complex business issues
• Leading and coaching staff
• Managing workflow and overseeing day-to-day department responsibilities
• Conducting operational meetings with staff
• Assisting management in establishing work goals
• Preparing management reports and budget variance

Financial Operations Analyst – Lead

Software Engineer

• Undertakes complex assignments requiring additional specialized technical knowledge
• Develops very complex and varied strategic report applications from a Data Warehouse
• Establishes and communicates common goal and direction for team
• Establishes and maintains advanced knowledge of data warehouse database design, data definitions, system capabilities, and data integrity issues
• Acts as a source of direction, training and guidance for less experienced staff
• Monitors project schedules and costs for own and other projects
• Develops and supports very complex Data Warehouse-related applications for business areas requiring design and implementation of database tables
• Conducts training on use of applications developed

Senior Business Info Developer Consultant

Program Manager

• Lead the Threat Management/Workplace Violence Prevention Program
• Set and enforce enterprise policies regarding workplace violence incidents
• Update company policies to align with best practices and government requirements
• Conduct after-action reviews and case studies
• Partner with security teams, human resources, legal and management to assess/manage threats
• Serve as a threat assessment expert and lead investigations
• Partner with business units to analyze trends and spearhead prevention programs
• Oversee training on workplace violence and emergency response procedures
• Create standards for measuring program efficiency
• Research and analyze emerging security threats
• Prepare threat assessments and reports for leadership

Threat Management Program Manager

Data Analyst

• Provides analytical support to the Cost of Care and/or Provider Contracting organizations
• Focuses efforts on lowering claims costs, improving quality of care, and increasing member and provider network satisfaction
• Provides expert advice, analytic and consultative support to Medical Directors and management on cost of care issues
• Works on large scale initiatives with high dollar cost savings opportunities
• Partners with provider contractors to develop contracting strategy and supports all aspects of the contract negotiation process
• Works on complex enterprise-wide initiatives and acts as project lead
• Uses analytic tools to track health risks and compliance
• Recommends policy changes and claim's system changes to pursue cost savings
• Reviews results post-implementation to ensure projected cost savings are realized

Cost of Care – Provider Contracting Data Analyst

• Perform care management within the scope of licensure for complex and chronic care needs
• Assess, develop, implement, coordinate, monitor, and evaluate care plans
• Conduct assessments to identify individual needs
• Implement care plans by facilitating authorizations/referrals
• Monitor and evaluate effectiveness of care management plans
• Interface with Medical Directors and Physician Advisors
• Assist in problem solving with providers, claims or service issues