Business Director - Integrity Ideation

Carelon Payment Integrity

Location:

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.

Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical‑expense spending.

Location:

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.

Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical‑expense spending.

The Business Change Director is responsible for working with management to identify and implement varied projects, programs and plans that support achievement of business unit and enterprise goals.

• May specialize in one area of organization effectiveness (planning, project portfolio, or culture/change) or be assigned to directly support a business unit and ensures activities are aligned with corporate strategy.
• Identifies potential issues, project change, and scope data.
• Leads efforts to identify best practices.
• Identifies impacted parties, business partners, and resources required.
• Develops and designs processes and systems that support business needs.
• Designs methods for integrating functions and processes.
• Conducts cost/benefit analyses.
• Builds support for business change throughout the business unit.
• Provides process, project, and change management methodology coaching/consulting support to both local and enterprise wide initiatives.
• Leads the project prioritization and scheduling activities for the business unit. Provides expertise to the business areas in culture/change management activities.
• Provides expertise in process planning and portfolio management activities.
• Supports the execution of the operating plan.
• This role is responsible for developing new audit concepts through, but not limited to, the following:
  Data models CMS and state Medicaid guidelines, Researching provider billing trends being influenced by revenue cycle vendors, Other publicly available information.
• Creates/audits reports and paid claims to identify over payment of claims. The scope may include Data Mining, Claim Adjudication, Contract Compliance, Provider Billing Reviews, Policy & Reimbursement Analysis, and Quality Assurance across various lines of business.
• Actively seeks information to understand rationale and provide exceptional results beyond basic standards.
• Creates innovation to enhance the standard operating rhythm finding new pathways to complete work expectations.
• Integrates information from various sources and considers broader context.
• Identify and solve problems by identifying errors and over payments within our Elevance enterprise.
• Multi‑functional in strategizing, disseminating, and implementing cross‑audit concepts to Elevance functional areas and stakeholders.

• Requires a BA/BS in a related field and minimum of 10 years managing mid to large‑scale change/project initiatives; or any combination of education and experience which would provide an equivalent background.

• Advanced understanding of the healthcare industry, as well as proven track record of…