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

Elevance Health•Indianapolis, IN

3d•Hybrid

About The Position

As a part of the Data Mining Overpayment and Operations team, the Business Analyst III is responsible for serving as the liaison between the business and IT in translating complex business needs into application software. 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 if candidates reside within a commuting distance from an office. 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.

Requirements

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.

Nice To Haves

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.

Responsibilities

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.