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

Elevance Health•Indianapolis, IN

3d•Hybrid

About The Position

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. As a part of the Data Mining Overpayment and Operations team, the Business Consultant is responsible for translating moderately complex and varied business needs into application software requirements. Possesses full technical knowledge of most phases of systems and business analysis and is able to consider the business implications of the application of technology to current and future business environments.

Requirements

Requires a BA/BS and minimum of 8 years business analysis experience, which should include analysis and project management; or any combination of education and experience which would provide an equivalent background.

Nice To Haves

Knowledge of systems capabilities and business operations is strongly preferred.
Deep expertise in claims processing, pricing, and overpayment analysis (WGS/CIW preferred).
Strong leadership, mentorship, and facilitation experience.
Ability to manage multiple priorities independently and drive results.
Experience identifying new recovery opportunities and improving processes.
Strong analytical and communication skills with stakeholder influence.

Responsibilities

May lead teams of analysts assigned to complex projects.
Determines specific business application software requirements to address complex and varied business needs.
Analyzes and designs solutions to address complex and varied business needs.
Consults with business partners concerning application and implementation of technology.
Analyze structured and unstructured data using automation/AI tools to identify trends, solve complex business problems, and uncover overpayment risks.
Partner with business stakeholders to interpret processes, contracts, and system rules, ensuring accurate validation of claims and overpayments.
Identify process and system risks, recommending and supporting automation and improvements to minimize risk and enhance outcomes.