Business Analyst II- Data Mining Overpayment and Operations/Payment Integrity-WGS Commercial Claims

Business Analyst II – Commercial Claims Data Mining Shift: Monday – Friday The Business Analyst II is responsible for translating basic business needs into application software requirements. Identifies, analyzes, and validates overpayment recovery opportunities. Determines specific business requirements to address complex business needs. Completes all required documentation to support workflow and reporting. Collaborates with the claims validation team to approve concepts for recovery. May provide direction and guidance to team members. How you will make an impact: Analyze claims data and contract/policy guidelines to identify and assess overpayment and prevention opportunities, including researching leads and evaluating complex scenarios. Translate business needs into clear requirements for prepayment solutions, partnering with data analysts on query design, testing (UAT), and implementation. Prioritize and manage work while identifying process improvements that drive increased savings and operational efficiency. Analyzes business needs to determine optimal means of meeting those needs. Determines specific business application software requirements to address specific business needs. 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. Minimum Requirements: Requires a BA/BS and minimum of 3 years related business analysis experience, or any combination of education and experience, which would provide an equivalent background. Preferred Skills, Capabilities, and Experiences: In-depth knowledge of WGS / CI&W Commercial Claims processing or adjustments is preferred. In-depth knowledge of WGS Pricing Arrangements for East Region - CT, ME, NH, GA, NY, VA commercial markets. Reimbursement Policies, Provider Contract, and Member Benefit expertise – highly preferred. Strong oral, written, and interpersonal communication skills, problem‑solving skills, facilitation skills, and analytical skills. Project management, ability to manage multiple projects in various stages to completion. Fluent in MS Excel. Benefits: We offer a range of market‑competitive total rewards that include merit increases, paid holidays, paid time off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs and financial education resources. Equal Employment Opportunity Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, and local laws. Applicants who require accommodation to participate in the job application process may contact View email address on click.appcast.io for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. #J-18808-Ljbffr Elevance Health