Carelon Payment Integrity Manager - Kansas

Job Title Carelon Payment Integrity Manager – Kansas Location Kansas Hybrid Work Model Associates required to be in office 1–2 days per week. Candidates must be within a reasonable commuting distance, unless accommodation is granted as required by law. Job Summary The Carelon Payment Integrity Manager – Kansas is responsible for ensuring the accuracy of claims payment through the prevention, detection, and correction of billing, payment, and membership errors. Working with health plan leaders, the manager oversees monitoring and enforcement of fraud, waste, and abuse compliance programs to prevent and detect potential fraud, waste, and abuse activities pursuant to state and federal rules and regulations. How You Will Make an Impact Coordinate and respond to inquiries from executives, ensuring timely and accurate communication. Handle the processing and management of Payment Integrity waivers. Assist in preparing responses to requests for proposals across all lines of business. Document process flows accurately to ensure clear and effective communication of processes. Help prepare presentations, ensuring they are polished and ready for delivery. Review and approve performance guarantees, ensuring compliance with standards. Apply detailed technical knowledge of claims payment accuracy and participate in cross‑functional teams focused on problem remediation and long‑term resolution. Anticipate the effect of changes in the business environment on future claim errors. Evaluate regulatory compliance and Health Care Reform changes to determine potential impact. Evaluate provider activities to assist in the detection of fraud, waste, and abuse activities. Monitor provisions of the compliance plan, including fraud, waste, and abuse policies and procedures, investigate unusual incidents, and implement corrective action plans. Develop and analyze monthly reports. Develop project plans and oversee project execution, issue management, and progress reporting. Develop processes to support early detection of systemic issues causing operational inefficiencies. Minimum Requirements BA/BS in business, engineering, nursing, finance, or healthcare administration. Minimum of 5 years of related work experience, including at least 2 years of leadership experience; or an equivalent combination of education and experience. Preferred Skills, Capabilities, and Experiences 2–5 years of experience with Fraud, Waste, and Abuse. Experience with payment integrity. Familiarity with claims systems and processes. Experience with GBD Facets. Job Details Job Level: Non‑Management Exempt Workshift: 1st Shift (United States of America) Equal Employment Opportunity Statement 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. Accommodation Statement Applicants who require accommodation to participate in the job application process should submit the Accessibility Accommodation Request Form and a member of the team will be in contact. #J-18808-Ljbffr The Elevance Health Companies, Inc.