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

• Analyzes complex claims data including identifying trends, overpayment risks, and opportunities for prevention.
  

• Identifies areas at risk and make recommendations on how to minimize the risk.
  

• Consults with business partners concerning processes, procedures, contracts, processing rules and other system rules.
  

• Performs analysis of structured and unstructured data to identify trends, solve complex business problems, and support overpayment detection using automation/AI tools.
  

• Collaborates with cross-functional teams to identify process gaps and recommend solutions that minimize risk and improve overpayment prevention and recovery outcomes.
  

• Works with business partners to ensure solutions are in place for leakage around automation and testing to validate potential overpayments.
  

• Acts as a resource and consultant to users and business partners, addressing questions related to systems, processes, procedures, and implementation of technology.
  

• May provide direction and guidance to team members, lead efforts on complex projects, and serve as a subject matter expert for the team.
  

• Requires a BA/BS and minimum of 5 years business analysis experience; or any combination of education and experience which would provide an equivalent background. Knowledge of systems capabilities and business operations is strongly preferred.
  

• Knowledge of systems capabilities and business operations is strongly preferred.
  

• Experience in payment integrity or recovery operations, including leakage analysis.
  

• Knowledge of WGS, pricing outcomes, and recovery/concept tools (e.g., PICM, ECM, ACR).
  

• Strong data analysis skills with ability to quantify trends and financial impact.
  

• Advanced Excel skills (pivots, formulas, VLOOKUPs, Power Query).
  

• Ability to communicate insights and partner to resolve process and automation gaps.
  

• Claims processing skills
  

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

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, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

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, or local laws. Applicants who require accommodation to participate in the job application process may contact View email address on aplitrak.com 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