Business Architect Sr - Claims Systems

Business Architect Sr.

- Claims Systems

Location:

This role requires associates to be in-office 1 day 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 Business Architect Sr.

- Claims Systems will be part of Elevance Health's National Operations Command Center (NOCC) which is responsible for E2E monitoring of operational, experience and financial performance across enterprise functions. The team leads deep root-cause analysis and permanent solution development on strategic enterprise-impacting issues.

How you will make an impact:

* Support Cost of Care and other claims-based root-cause investigations leveraging intimate claims system and business process knowledge to evaluate claims system configuration and logic compared to expected workflows

* Conduct sophisticated data analysis and synthesize findings into root-cause contributors and organizational and/or stakeholder experience impact

* Based on system root-cause findings, recommend process and/or system enhancements to permanently solve identified issues, converting business requirements into technical requirements and managing the handoff to technology implementation teams

* Provide linkages to other Enterprise Architecture groups and models, coordinate and align activities to achieve the future state capabilities with Business Relationship Management (BRM) skills, and confirm solutions work as intended

* Contributes to providing linkage to other Enterprise Architecture groups and models, and coordinate and align activities to achieve the future state capabilities with Business Relationship Management (BRM)

* Leads Reference architectures, Strategic Business Architecture (SBA) and Operational Business Architecture (OBA) that articulate a future state direction to optimize the value chain

* Leads Business Architecture portion of business blueprints, including establishing guiding principles, defining capabilities, performing functional analysis/definition, analyzing and documenting the value chain, and assessing organizational impacts

* Creates initiatives to perform enterprise wide functional analysis to identify areas for efficiencies or rationalization opportunities, and conduct ongoing analysis of business capabilities and how improvements to architecture components can best support capabilities

* Reviews a common process for how projects are assessed against business architecture artifacts and blueprints; incorporate into overall architecture governance process

* Translates strategic decisions into operational and process-focused plans for a market segment

* Analyzes and applies emerging organizational paradigms aligned to strategic needs

* Communicates and builds consensus equally effectively with many constituents, including business executives, technologists, end users, and operations

Minimum Requirements:

Requires an BA/BS degree in Information Technology, Computer Science or related field of study and a minimum of 7 years experience in business analysis and strategic planning, IT operations, IT planning, IT leadership, or strategic and technical architecture; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

* 3+ years of experience with Claims System SME (WGS/FACETS) strongly preferred.

* Experience with the following systems strongly preferred: EDI/EDINET; SQL; JIRA; FACETS (CENTRAL/GBD); WGS MAINFRAME & CIW; WEBSTRAT;
Authorization Overwrite Tool (AO Tool) .Net UI;
Claims Workstation Pega UI.

* Have sound claims process and data knowledge including:
Claims Train data, CAST Train data; CAST Lights On mgmt., E2E claim lifecycle Vetting; FICR; MGCT# Post adjudication; CPEC-Claims Payment Extract and Capitation; CIFT, CFE; GBD IT Pre/Post-Adjudication; COPS; UM MATCH LOGIC; PROVIDER/PRICING CONFIG utilization.

* Data & Analytics experience with our the following tools strongly preferred:
EdWard, OPAL, OBI, EDI.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are…