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.

Wellpoint Federal, a subsidiary of Elevance Health, brings deep industry expertise and healthcare service capabilities to support federal programs. The organization delivers solutions across claims administration, data, and care delivery to help address complex challenges and improve health outcomes for federal populations.

The Business Claims Analyst II is responsible for translating basic business needs into application software requirements.

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 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

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.

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $61,680 to $92,520

Locations: Maine, New York, Virginia

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.