Elevance Health

Consultant

• Calculates renewal rates for large complex cases based on thorough analysis of experience data, location, demographics, etc.
• Provides guidance to the actuarial team for administrative service costs associated with risk opportunities.
• Coordinates with other departments to ensure accuracy on resource allocation and consistency of overall account reporting.
• Proposes various rate structures for prospective business utilizing a combination of other carrier experience, demographic data and manual rates.
• Facilitates and documents deal approval process
• Performs post-sale reviews.
• Prepares or supervises preparation of annual settlements, ERISA reports, rate projections, or benefit change increments and decrements.
• Surveys existing product portfolios by market, monitors sales results, trends and needs, recommends product portfolio changes.
• Assists in establishing rating and administrative procedures.
• Participates in major multi-functional teams as underwriting representative.
• Assists in the technical development of underwriting associates.
• Updates and monitors departmental processes and procedures in compliance with system, regulatory and business requirements.

Senior Group U/W Consultant

Actuary

• Completes diverse and complicated projects and performs highly complex actuarial studies
• Performs key actuarial functions including new product pricing and evaluation of the impact of new legislation
• Designs and completes special projects such as developing and maintaining experience-rating formulae
• Responsible for recommendations on pricing, marketing, product design, claims, premium and enrollment administration of business unit
• Provides valuation support for business unit by interpreting financial results

Associate Actuary

• Supports Employee Assistance Program (EAP) service department by responding to initial customer contacts and request for services
• Receives client request, assesses situation, determines appropriate course of action
• Provides telephone and or on-site support for crisis intervention, assessment, short term problem resolution and referral to appropriate provider(s)
• Manages Critical Incident Stress Debriefing requests
• Assesses members and assists them in accessing behavioral healthcare benefits available under their health plan
• Manages shared mailbox that is used by clients and external vendor to forward information that must be reviewed and placed in documentation system

Behavioral Health EAP Consultant I

Medical Director

• Oversee the administration of behavioral health services
• Provide clinical consultation and strategic guidance
• Ensure timely and consistent responses to members and providers
• Conduct peer-to-peer clinical reviews
• Serve as a resource and consultant to other areas of the company

Behavioral Health Medical Director – Psychiatrist

Underwriter

• Calculates renewal rates for large complex cases based on thorough analysis of experience, location, demographics, etc.
• Determines and provides guidance to medical underwriters concerning the risk selection of applicants applying for individual health coverage.
• Coordinates with other departments to ensure accuracy and consistency of overall account reporting.
• Proposes rates for prospective business utilizing a combination of other carrier experience, demographic data and manual rates.
• Performs post-sale reviews.
• Surveys existing product portfolios by market, monitors sales results, trends and needs, recommends product portfolio changes.
• Assists in establishing rating and administrative procedures.
• Participates in major multi-functional teams as underwriting representative.
• Assists in the technical development of underwriting associates, which may include monitoring reports and workflow to provide recommendations on productivity and efficiency improvements.
• Updates and monitors departmental processes and procedures in compliance with system, regulatory and business requirements.

Stop Loss Group Underwriting Consultant

Bilingual

• Responsible for new and existing patients
• Outreach to patients, explaining the benefits of programs, and guiding them through the enrollment process
• Reviewing and prioritizing patient census
• Reaching out to patients to explain services and enrolling them into the appropriate programs
• Coordinate with internal teams to ensure seamless patient onboarding
• Meet or exceed enrollment targets and key performance indicators
• Providing support by addressing inquiries and scheduling initial and annual appointments
• Enters documentation into designated systems

Patient Enrollment Specialist, Bilingual Gujarati

• Calculates renewal rates for large complex cases based on thorough analysis of experience, location, demographics, etc.
• Determines and provides guidance to medical underwriters concerning the risk selection of applicants applying for individual health coverage.
• Coordinates with other departments to ensure accuracy and consistency of overall account reporting.
• Proposes rates for prospective business utilizing a combination of other carrier experience, demographic data and manual rates.
• Performs post-sale reviews.
• Prepares or supervises preparation of annual settlements, ERISA reports, rate projections, or benefit change increments and decrements.
• Surveys existing product portfolios by market, monitors sales results, trends and needs, recommends product portfolio changes.
• Assists in establishing rating and administrative procedures.
• Participates in major multi-functional teams as underwriting representative.
• Assists in the technical development of underwriting associates, which may include monitoring reports and workflow to provide recommendations on productivity and efficiency improvements.
• Updates and monitors departmental processes and procedures in compliance with system, regulatory and business requirements.

Group Underwriting Consultant

• Calculates renewal rates for large complex cases based on thorough analysis of experience, location, demographics, etc.
• Determines and provides guidance to medical underwriters concerning the risk selection of applicants applying for individual health coverage.
• Coordinates with other departments to ensure accuracy and consistency of overall account reporting.
• Proposes rates for prospective business utilizing a combination of other carrier experience, demographic data and manual rates.
• Performs post-sale reviews.
• Surveys existing product portfolios by market, monitors sales results, trends and needs, recommends product portfolio changes.
• Assists in establishing rating and administrative procedures.
• Participates in major multi-functional teams as underwriting representative.
• Assists in the technical development of underwriting associates, which may include monitoring reports and work flow to provide recommendations on productivity and efficiency improvements.
• Updates and monitors departmental processes and procedures in compliance with system, regulatory and business requirements.

Senior Stop Loss Group Underwriting Consultant

• Responsible for new and existing patients
• Outreach to patients, explaining the benefits of programs
• Guiding patients through the enrollment process
• Reviewing and prioritizing patient census
• Coordinating with internal teams for seamless onboarding
• Meeting or exceeding enrollment targets and KPIs

Patient Enrollment Specialist, Bilingual Cantonese

• Reviewing and prioritizing patient census
• Reaching out to patients to explain services and enrolling them into the appropriate programs based on the line of business
• Coordinate with internal teams, including clinical and care coordination teams, to ensure seamless patient onboarding
• Meet or exceed enrollment targets and key performance indicators
• Providing support by addressing inquiries and scheduling the initial and annual appointments
• Enters documentation into the designated systems

Patient Enrollment Specialist, Bilingual Spanish

Director

• Directs the enterprise payor contracting strategy for an infusion pharmacy organization
• Develops and leads comprehensive contracting strategy
• Serves as a strategic advisor to executive leadership
• Leads complex negotiations with national and regional health plans
• Oversees contract modeling, financial impact analysis, and ongoing performance monitoring
• Partners with finance, operations, and clinical teams
• Acts as the primary liaison between contracting and internal stakeholders
• Leads, mentors, and develops a team of payor contracting professionals
• Ensures contracting activities align with federal and state regulations

Director of Payor Contracting – Infusion

• Leads pricing strategy, financial modeling, and payor negotiation support for infusion and specialty pharmacy services
• Develops and maintains pricing models across drug, professional, supply, and ancillary components
• Serves as the pricing lead for payor negotiations with national, regional, and local health plans, PBMs, and employer groups
• Analyzes contract performance after implementation to confirm expected reimbursement and margin outcomes
• Partners with Revenue Cycle, Billing, Trade, Finance, and Operations to ensure pricing terms are operationalized accurately and consistently
• Establishes pricing governance, approval processes, and documentation standards

Director, Pricing

Manager

• develops the provider network through contract negotiations (language and rates)
• relationship development and servicing
• primary focus is contracting and negotiating contract terms
• typically works with less-complex to complex providers
• conducts more complex negotiations and drafts documents
• assists in preparing financial projections and conducting analysis as required

Provider Network Manager

Artificial Intelligence

• Analyze business, product, and technology workflows and design multi-agent systems
• Perform analysis on current capabilities versus desired capabilities
• Conduct testing and ensure standard processes, policies, and guidelines are utilized
• Document workflows and assist in training associates on new processes
• Facilitate process design meetings and execute implementation plans for new processes
• Monitor emerging advancements in agentic AI and translate innovations into practical solutions

Agentic AI Process Engineer, Senior

Business Analyst

• Performs continuous analysis and projects if resulting metrics will increase or decrease call volume in the long-term (typically 12-18 months)
• Designs, builds and maintains databases and/or spreadsheets tracking key service statistics
• Analyzes and interprets staffing model results by isolating and analyzing trends and assessing business impacts
• Captures call baseline data, recording and removing volume-driven events, determines historical patterns, incorporates incremental drivers, and incorporates shrinkage patterns through analysis of past data
• Predicts future impact on call drivers
• Develops a long-term service level plan with specific actions based on gaps identified by the model
• Meets with management to review staffing models and to make improvements on future forecasts
• Determines long-term needs and loads the forecast into the WFM system
• Serves as expert on WFM software and may be point of contact for systems related issues