Program Administrator- Carelon Payment Integrity

Elevance Health•Louisville, KY

7d•Hybrid

About The Position

The Program Administrator is responsible for the administration of one or more client-facing programs within a business unit. Program administrators typically support business strategies through an integrated portfolio of external client-facing projects or initiatives. 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. Among us are specialty-care physicians, nurse practitioners, pharmacists, engineers, data scientists, and other dedicated and caring health professionals. While our roles may differ, our purpose is shared: to make a positive impact on whole health.

Requirements

BA/BS in a related field and a minimum of 2 years of experience in an external client-facing program or other healthcare-related field; or any combination of education and experience, which would provide an equivalent background.

Nice To Haves

Professional designation related to the field or project management experience preferred.
Understanding of the application of applicable systems and knowledge of medical and pharmacy terminology and HIPAA regulations strongly preferred.
Healthcare industry knowledge and experience preferred.
Payment integrity experience preferred. E.G. Subrogation, Coordination of benefits (COB), Data Mining, Fraud, Waste and Abuse etc.
Proficient in Microsoft Office Suite (Excel, Word, PowerPoint, Outlook) preferred.
Ability to prioritize competing requests and escalate appropriately preferred.
Strong research and problem-solving skills; able to find answers across multiple sources and summarize clearly is strongly preferred.

Responsibilities

Assists with the development and implementation of procedures from the customer service aspect for all clients (internal and external).
Assists in the strategy and implementation of new products and services from the production operations perspective.
Assists in the management of a high-volume shared mailbox by monitoring incoming messages, triaging, and prioritizing requests, assigning/forwarding items as needed, and ensuring timely, accurate responses.
Track inquiries from intake through resolution, perform research to identify answers, and coordinate with internal teams to close out open items.
Validate client reports for accuracy, completeness, and consistency prior to delivery.
Track expected vs. received files and promptly identify missing, late, or failed transmissions.
Review, validate, and implement client exclusion and special handling changes; confirm updates are reflected across all required platforms/tools.
Assist with loading recovery files and researches and resolves any file load exceptions by analyzing source data and matching records to the correct member/group eligibility combinations.
Perform regression testing following system releases to validate existing functionality and identify unintended impacts.
Implement letter template changes (content, variables, formatting) and validate outputs through testing/quality checks prior to use.
Other ad hoc projects/tasks as needed.