Medicare Claims Analyst II — Hybrid, Data-Driven

Business 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. Anticipated End Date: 2026-05-29 How you will make an impact: 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, Capabilities and Experiences: Minimum of two (2) years of experience working within a Claims Operations environment. 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. Salary range: $61,680 to $92,520 Locations: New York 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