Elevance Health

Business Analyst

• Conduct outbound provider calls to confirm that services were rendered, and that the provider was expecting payment.
• Review claim details to determine claim validity before initiating outreach, ensuring all required information is accurate and complete.
• Meet or exceed daily outbound call attempt requirements as established by departmental performance metrics.
• Maintain a QA (Quality Assurance) score of 95% or higher, demonstrating adherence to process, accuracy in documentation, and professionalism in communication.
• Meet all Service Level Agreement (SLA) requirements related to outreach, documentation, and productivity.
• Provide excellent customer service when interacting with providers, addressing questions politely and professionally.
• Follow Desk Level Procedures (DLPs), workflows, and operational guidelines to ensure consistency and compliance in all outreach activities.
• Accurately document call outcomes and follow-up activities in required systems.
• Review and evaluate payment integrity recovery requests from external partners to determine validity and appropriateness.
• Analyze claim data to confirm recovery eligibility using applicable CPT, HCPCS, and ICD-10 codes.
• Utilize systems such as Facets and Macess to research claims, validate overpayments, and document findings.
• Collaborate with internal teams to clarify claim details and ensure accurate communication with partners.
• Prepare and maintain detailed documentation supporting recovery decisions.
• Provide recommendations for process improvement and assist with the implementation of corrective actions.
• Ensure compliance with all internal policies, regulatory requirements, and partner agreements.

Provider Outreach Business Analyst II

Security Engineer

• Direct and execute the strategic cybersecurity threat management vision that scales globally to effectively secure our business without slowing company innovation.
• Deliver and support a robust cybersecurity framework to protect our systems/networks/data and business on a 24x7x365 basis.
• Maintain responsibility, primarily cyber defense strategy, architecture, engineering, and operations.
• Direct the management of cybersecurity domains or suites, ensuring efficient capital & labor utilization; budget development; compliance with regulatory requirements.
• Influence and drive a strong security culture organization-wide across all tiers.
• Frequently interacts with IT and business units to understand their plans, risk posture, and aligns threat management vision and operational plans; protects against current and emerging threats combined with active monitoring.
• Ensure implementation, monitoring, and updates of disaster recovery and business continuity plans with a cybersecurity focus to enable business, operational, and cyber resilience.
• Establish and nurture collaborative relationships with key business and security partners.
• Hire, train, mentor, coach, counsel, and manage a high-performing cybersecurity team, evaluating performance to achieve strategic goals.
• Direct and deliver forward-facing efforts on AI Cyber defense.

Director II, Cybersecurity – Cyber Defense, Security Analytics

Manager

• responsible for care management within the scope of licensure for members with complex and chronic care needs
• assessing, developing, implementing, coordinating, monitoring, and evaluating care plans
• ensures member access to services appropriate to their health needs
• conducts assessments to identify individual needs and a specific care management plan
• implements care plan by facilitating authorizations/referrals as appropriate within benefits structure
• 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
• assists with development of utilization/care management policies and procedures

Telephonic Nurse Case Manager II

Program Manager

• This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training.
• Collaborate with territory representatives to leading the increased business generation and customer retention.
• Develops and maintain business relationships with local chapters, clinics, and healthcare providers to enhance the business unit presence and impact in respective territories.
• Utilize lifestyle tools and resources within the QOL program to empower patients in managing their health, thus fostering a sense of control over their condition.
• Strategically integrate QOL initiatives into sales efforts to shorten the sales cycle and promote seamless health management solutions for patients.
• Leverage the QOL program as a significant referral source, contributing to business growth while maintaining cost-effectiveness compared to traditional event sponsorships.
• Monitor and evaluate the effectiveness of QOL programs regularly, making data-driven adjustments to ensure optimal patient engagement and satisfaction.
• Collaborate with cross-functional teams to align QOL initiatives with overall company objectives and marketing strategies.
• Travels to worksite and other locations as necessary.

Quality of Life Program Manager – Hemophilia

Financial Planning and Analysis

• Audits paid claims for identified overpayments using various techniques
• Responsible for more complex issues such as coordination of benefits, Medicare, and medical policies
• Works closely with staff from other departments on customer satisfaction
• Works closely with contract managers to identify and correct contractual issues
• May perform collection activities to ensure the recovery of overpayments and maintenance of unprocessed cash
• Researches voluntary refunds for accuracy
• Requires accurate balancing of all accounts

Financial Operations Recovery Specialist II

Content Writer

• Partner with business leaders to define goals for acquiring and retaining clients across Large Group, National Accounts, GRS, and Carelon.
• Assess the effectiveness of communication plans, strategies, and materials, and recommend improvements.
• Collaborate with creative teams to understand audience needs and deliver high-quality communications with quick turnaround times.
• Research, write, edit, and review content for proposal executive summaries, sales events, finalist and capabilities meetings, as well as retention and renewal presentations.
• Ensure all materials meet business and legal requirements, follow corporate standards, guidelines, and approval processes.
• Identify opportunities to improve efficiency and support key initiatives, including plain language, standardization, brand voice, company pillars, and accurate legal and site references.

Marketing Communications Writer

• Responsible for performing care management within the scope of licensure for members with complex and chronic care needs
• Assessing, developing, implementing, coordinating, monitoring, and evaluating care plans
• Conducting assessments to identify individual needs and a specific care management plan
• Implementing care plan by facilitating authorizations/referrals as appropriate
• Coordinating internal and external resources to meet identified needs
• Monitoring and evaluating effectiveness of the care management plan
• Interfacing with Medical Directors and Physician Advisors for treatment plans
• Assisting in problem solving with providers, claims or service issues

Nurse Case Manager I – NICU

Administration

• Assists with the development and implementation of procedures from the customer service aspect for all clients (internal and external)
• Assists in the strategy and implementation of new products and services from the production operations perspective
• Assists in the management of a high-volume shared mailbox by monitoring incoming messages, triaging, and prioritizing requests, assigning/forwarding items as needed, and ensuring timely, accurate responses
• Track inquiries from intake through resolution, perform research to identify answers, and coordinate with internal teams to close out open items
• Validate client reports for accuracy, completeness, and consistency prior to delivery
• Track expected vs. received files and promptly identify missing, late, or failed transmissions
• Review, validate, and implement client exclusion and special handling changes; confirm updates are reflected across all required platforms/tools
• Assist with loading recovery files and researches and resolves any file load exceptions by analyzing source data and matching records to the correct member/group eligibility combinations
• Perform regression testing following system releases to validate existing functionality and identify unintended impacts
• Implement letter template changes (content, variables, formatting) and validate outputs through testing/quality checks prior to use
• Other ad hoc projects/tasks as needed

Program Administrator – Carelon Payment Integrity

Learning and Development

• Facilitates learning events that are performance-based in nature.
• Delivers synchronous and asynchronous learning events using varied media in virtual and in-person environments.
• Employs rapid course development methodologies to quickly meet market needs.
• Exercises management of the learning environment including learner performance and escalates issues to leadership.
• Measures, tracks and evaluates learner and market satisfaction.
• Thinks and acts globally and is aware of adult learning and cultural differences that drive learner effectiveness.
• Keeps technical skills updated.
• Travels to worksite and other locations as necessary.

Training Specialist – LTSS Service Coordination

Account Manager

• Serves as primary Pharmacy Business Driver leading Account Management
• Communicates the Company value proposition to clients and prospects and meeting revenue goals, profitability, satisfaction, and retention parameters as per the Key Performance Indicator (KPI) structure
• Delivers client retention and satisfaction strategies that drive results, execution excellence
• Involves significant engagement with matrixed resources that support accounts, resulting in client satisfaction and retention
• Works with internal partners to develop client strategies that drive growth, retention, ongoing profitability, and operational excellence
• In collaboration with VP & Chief Sales Officer CarelonRx, helps align pharmacy services team efforts with business objectives
• Interacts with Anthem leadership, including regional leaders, plan presidents, and other key stakeholders responsible for customer experience
• Builds solid internal cross-functional relationships at all levels of Client Management, Finance, Operations, and IT
• Involves launching, expanding, and enhancing the CarelonRx pharmacy growth and retention model in collaboration with Anthem leadership and market regional sales/account management leaders
• Works with market account management leaders to develop and implement client-specific retention strategies and broader solution upselling strategies to meet business objectives
• Hires, trains, coaches, counsels, evaluates performance of direct reports

RVP, CarelonRx Account Management – West Region

Artificial Intelligence

• Determines how decision support systems and AI-enabled solutions will provide the data required to make effective business decisions.
• Performs modeling of information sources, dataflows, and analytical pipelines.
• May coordinate the activities of a project team and monitor project schedules and costs for own projects.
• Create and maintain reporting and advanced analytical solutions leveraging enterprise data platforms.
• Ensure data quality, integrity, and alignment with enterprise data architecture.
• Develops and supports complex data warehouse-related and analytical applications, including scalable data pipelines and model ready datasets.
• The majority of time will be spent hands on coding, data analysis, and building reusable analytical/AI components.
• Provide training and guidance on analytics tools, models, and data products.

Advanced Analytics & AI Consultant

Cloud Engineer

• Define enterprise AI/ML architecture strategy across multiple cloud providers (AWS, Azure, GCP)
• Author and evangelize whitepapers/position papers defining principals and strategies for AI/ML cloud platforms
• Liaison with Enterprise Architecture, Enterprise Data and Analytics, and Information Security teams to design and enhance end-to-end ML pipelines including data ingestion, feature engineering, training, deployment, and monitoring
• Establish ML Ops standards for cloud (CI/CD for ML, model registry, feature store, monitoring) and cloud control frameworks to support these
• Drive adoption of responsible AI, model governance, and risk management frameworks
• Partner with data science teams to operationalize models at scale
• Serve as a technical ‘Sherpa’ for Elevance projects leveraging AI/ML in any public cloud provider
• Evaluate and implement ML platforms (SageMaker, Vertex AI, Azure ML, Databricks ML, etc)
• Enable real-time and batch inference architectures
• Establishes overall systems architecture vision and ensures specific components are appropriately designed and leveraged; contributes to the holistic vision of Enterprise Architecture
• Maintains components of architecture strategy and vision
• Maintains enterprise level blueprints
• Coordinates all enterprise-level conceptual architecture components (e.g., data architecture, application architecture, technical architecture)
• Monitors usage of architectural components and assumes responsibility for reuse
• Drives system migration based upon roadmaps defined in enterprise and domain blueprints
• Leads architecture strategy and vision for enterprise
• Ensures blueprints are refreshed as needs emerge or in accordance to plan of record changes
• Provides continuous consulting services and direction in projects and architectures
• Champions and is responsible for enterprise level technology and architectural standards, guidelines, principles, frameworks, and reference models

Principal Cloud Engineer – AI/ML

Customer Support

• Responds to internal and external customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility and claims
• Analyzes problems and provides information/solutions
• Operates a PC/image station to obtain and extract information and documents information, activities and changes in the database
• Develops and maintains positive customer relations
• Researches and analyzes data to address operational challenges and customer service issues

Customer Care Representative I

Bilingual

• Provides urgent health care via telephone and tele video modalities to patients who receive home and community-based services through state Medicaid programs, dual eligible members and other membership as assigned by our MCO partners
• Develops and implements clinical plans of care for adult patients facing chronic and complex conditions (e.g., co-morbid medical and mental health diagnoses, limited personal resources, chronic medical conditions.)
• Gathers history and physical exam and diagnostics as needed, and then develops and implements treatment plans given the patient’s goals of care and current conditions
• Identifies and closes gaps in care
• Meets the patient’s and family’s physical and psychosocial needs with support and input from the company’s inter-disciplinary team
• Educates patients and families about medication usage, side effects, illness progression, diet and nutrition, medical adherence and crisis anticipation and prevention
• Maintains contact with other clinical team members and other medical providers to coordinate optimal care and resources for the patient and his or her family in a timely basis and consistent with state regulations and company health standards and policy
• Maintains patient medical records and medical documentation consistent with state regulations and company standards and policy
• Participates in continuing education as required by state and certifying body
• Prescribes medication as permitted by state prescribing authority

Bilingual Nurse Practitioner

Systems Engineer

• Defines functionality, usability, reliability, performance and support requirements of a system.
• Creates and performs feature testing and determines environmental needs.
• Provides the link between the technical and business views of the system.
• Partners with business, architecture and infrastructure to ensure business area satisfaction.
• Mentors and assists in training initiatives.
• Proactively works with stakeholders to identify future system opportunities and enhancements.
• Develops use cases.