Manager Process Improvement - Payment Integrity

Elevance Health • Atlanta, IL

25d • Hybrid

About The Position

Manager Process Improvement - Payment Integrity Location : It is highly preferred that the selected candidate resides in one of the following cities/states: Chicago, IL; Miami, FL; Tampa, FL; Atlanta, GA; Indianapolis, IN; Nashville, TN; Grand Prairie, TX. Hybrid 2 : This role requires associates to be in-office 3 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. The Manager Process Improvement is responsible for building and leading a team that delivers advanced trend and anomaly analytics and translates Payment Integrity insights into meaningful provider and market-level action, with the overall goal of increasing medical savings and improving payment accuracy. Primary duties may include, but are not limited to: Oversees a team responsible for engaging the provider community using data-driven insights to support improved post-pay Payment Integrity outcomes, provider behavior change, and audit effectiveness. P artners closely with Payment Integrity audit, analytics, operations, and market leadership to prioritize opportunities, guide provider engagement strategies, and align actions with enterprise Payment Integrity objectives Proactively identifies opportunities for improvement. Researches, develops, and implements related best practices. Develops metrics to track performance and goal achievement; serves as internal consultant relative to continuous improvement initiatives. P rovides strategic oversight of provider-level analysis aligned by market and state, identifying emerging trends, utilization patterns, and anomalies by extending analytic thresholds and exploring non-obvious patterns within complex claims data. Accountable for team development, performance management, and ensuring consistent, high-quality delivery of analytics-informed provider engagement that supports recovery optimization, compliance, and sustainable medical savings.

Requirements

• Requires a BA/BS in a related field and minimum of 5 years management experience with process improvement, project/program management, process engineering and/or performance improvement initiatives; or any combination of education and experience, which would provide an equivalent background.

Nice To Haves

• 5 years of experience in healthcare analytics, payment integrity, provider performance, operations, or related healthcare functions preferred.
• Demonstrated experience using data and trend analysis to identify anomalies, utilization patterns, and opportunities that drive measurable medical savings preferred.
• Experience partnering with operations, product, and technology teams to identify opportunities to automate, digitize, and streamline analytics- and provider-facing workflows, improving efficiency, scalability, and impact of Payment Integrity initiatives preferred.
• Proven experience working cross-functionally with operations, product, and technology teams to modernize processes through automation and digital enablement, reducing manual effort and accelerating insight-to-action execution preferred.
• Six Sigma Black Belt certification, related process improvement certification or PMI certification preferred.

Responsibilities

• Oversees a team responsible for engaging the provider community using data-driven insights to support improved post-pay Payment Integrity outcomes, provider behavior change, and audit effectiveness.
• Partners closely with Payment Integrity audit, analytics, operations, and market leadership to prioritize opportunities, guide provider engagement strategies, and align actions with enterprise Payment Integrity objectives
• Proactively identifies opportunities for improvement.
• Researches, develops, and implements related best practices.
• Develops metrics to track performance and goal achievement; serves as internal consultant relative to continuous improvement initiatives.
• Provides strategic oversight of provider-level analysis aligned by market and state, identifying emerging trends, utilization patterns, and anomalies by extending analytic thresholds and exploring non-obvious patterns within complex claims data.
• Accountable for team development, performance management, and ensuring consistent, high-quality delivery of analytics-informed provider engagement that supports recovery optimization, compliance, and sustainable medical savings.

Benefits

• 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).
• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager