Carelon Integrity Commercialization; Client Systems

Carelon Payment Integrity Commercialization (Client Systems Support)

Location
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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.

PLEASE NOTE:
This position is not eligible for current or future visa sponsorship.

The Carelon Payment Integrity Commercialization (Client Systems Support) is responsible for serving as a liaison between the customer/provider and the technology group.

• Assists with the development and implementation of procedures from the customer service aspect for all clients (internal and external).
• 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.
• Assists in the strategy and implementation of new products and services from the production operations perspective.
• Troubleshoots client system questions and processes.

• Requires a BA/BS degree and a minimum of 0 years of experience or any combination of education and experience, which would provide an equivalent background.

• 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).
• Ability to prioritize competing requests and elevate appropriately.
• Strong research and problem‑solving skills; able to find answers across multiple sources and summarize clearly.

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.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.

Applicants who require accommodation to participate in the job application process may contact elevancehealthj for assistance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Elevance Health requires all new candidates in certain patient/member‑facing roles to become vaccinated against COVID‑19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.