Business Claims Analyst II - Wellpoint Federal

Business Claims Analyst II – Wellpoint Federal Location This role requires associates to be in-office 1–2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Business Claims Analyst II is responsible for translating basic business needs into application software requirements. Responsibilities 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 BA/BS and minimum of 3 years related business analysis experience, or any combination of education and experience, which would provide an equivalent background. This position is part of our Wellpoint Federal division which, per CMS TDL 190275, requires foreign national applicants meet the residency requirement of living in the United States at least three of the past five years. Preferred Skills and Experience Minimum of two (2) years of experience working within a Claims Operations environment highly preferred Prior experience supporting Medicare Fee-for-Service (FFS) claims processing strongly preferred. Demonstrated understanding of Part A and/or Part B claims workflows, including regulatory requirements, CMS guidance, and CR/TDL implementation processes. Experience responding to external audits, CMS inquiries, compliance requests, and cross-functional operational initiatives. Proven ability to identify process improvement opportunities and drive standardization across teams. Experience developing or maintaining SOPs, job aids, and centralized documentation repositories. Strong collaboration skills with the ability to work across operational areas (e.g., Clinical Claims, Appeals, Provider Enrollment, EDI, Contact Centers, and other business partners). Ability to analyze operational trends, recommend solutions, and support innovation initiatives within a regulated environment. Comfortable working with data (Excel, basic SQL is a plus) and using tools like Power BI to review and share insights Foundational understanding of AI capabilities in healthcare and how they can support process improvement or reduce manual work Government Business Division If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a 'sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed. Salary & Location This position offers a salary range of $61,680 to $92,520. Locations Maine, New York, Virginia Benefits In addition to your salary, Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase plan, 401(k) contribution, and other benefits subject to eligibility requirements. Legal and EEO Information 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 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. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration. #J-18808-Ljbffr Elevance Health