Elevance Health

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.
• 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

Bilingual

• 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

Senior Workforce Management Analyst

Medical Director

• Ensures timely completion of clinical case reviews for their board certified specialty
• Makes physician to physician calls to gather appropriate medical information for medical necessity determinations
• Makes medical necessity determinations for grievance and appeals appropriate for their specialty
• Ensures consistent use of medical policies when making medical necessity decisions
• Brings to their supervisors attention, any case review decisions that require Medical Director review

Associate Medical Director – Interventional Pain

• Collaborate with business stakeholders and product/digital teams to gather and document requirements for IT projects
• Maintain open communication between IT teams and business units
• Facilitate solution development by translating business needs into technical specifications
• Identify potential issues, project changes, and scope data
• Conduct cost/benefit analyses and build support for business change throughout the business unit
• Provide process, project, and change management methodology coaching

Business Change Director – SIU Fraud and Abuse

AI Engineer

• Analyze and model organizational data for AI function to draw business insights
• Apply data extraction, transformation and loading techniques for large data sets
• Develop LLM strategies and enhance AI ML model deployment efficiency
• Design and develop custom ML, Gen AI, NLP, LLM Models for AI ML pipelines
• Work closely with MLOps team to create and maintain evaluation solutions for models
• Collaborate with product teams and stakeholders for deployment in production environments
• Ensure adherence to standards, governance, and best practices in ML model development

Gen AI Engineer

• perform care management within the scope of licensure for members with complex and chronic care needs
• assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care
• performing duties telephonically or on-site such as at hospitals for discharge planning
• ensure members understand benefits and assist in access of services appropriate to their health needs
• conduct assessments to identify individual needs and a specific care management plan
• implement care plan through actions based on assessments
• coordinate internal and external resources to meet identified needs
• monitor and evaluate effectiveness of the care management plan and modify as necessary
• interface with Medical Directors and other health professionals on the development of care management treatment plans
• assist in problem solving for members and providers related to access to care, vendors, claims or service issues

Telephonic RN Nurse Case Manager I

Content Marketing Manager

• Driving the development and execution of the clinical content scope in alignment with the product and content strategy to meet financial and operational targets
• Researching and interpreting CMS, CPT/AMA and other major payer policies based on medical coding and regulatory requirements
• Identifying common error areas that can be made into automated software logic to prevent overpayments from occurring
• Taking edits from concept to specification and then through review, testing and finally data validation
• Developing claims editing logic and content that promote payment accuracy and transparency
• Leading fee schedule development for specific plan(s) and/or the development and implementation of clinical editing rules
• Working with business partners to assist with cost of care claim editing goals
• Performing and/or directing complex fee modeling exercises to ensure that projected unit reimbursement changes meet corporate cost targets
• Reviewing healthcare policy (Medicaid manuals, fee schedules, CCI, OIG Alerts, LCAs/LCDs, NCDs, Medicare manuals, etc.) for coding and billing guidelines that can be turned into software editing rules
• Creating billing edits that provide clients with monetary savings and promote coding accuracy
• Preparing and presenting cost of care data analysis to support the regions cost of care initiatives
• Developing and maintaining the provider reimbursement strategy that will lower the cost of care, improve service, and reduce administrative expenses
• Managing special projects and initiatives

Manager, Clinical Content – Reimbursement

Analyst

• Develops statistical subject matter expertise of the research data and integrated environment, and data products.
• Leads and supports statistical analyses using research methods in emerging real-world data sources and clinical research.
• Assists in reviewing and advising on data management activities.
• Supports development of statistical content for study documentation and client-facing deliverables.
• Performs analytic methodology execution, including writing programming specifications and developing programs for statistical analysis.
• Contributes ideas for new analyses, data products, and research projects, and provides analytic insight to support product development efforts.
• Articulates methods, process, progress and results to internal and external stakeholders.
• Collaborates with the Scientific and Project Management teams to ensure adherence to scope, schedule, and quality expectations.