Business Analyst II - Payment Integrity Datamining

Anticipated End Date:

Position Title:

Business Analyst II - Payment Integrity Data mining

Business Analyst II – Payment Integrity Data mining

Location:

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.

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, a proud member of the Elevance Health family of companies, is a healthcare services organization that takes a whole-health approach to making care more integrated, personalized, and affordable. We put people at the center—connecting physical, behavioral, social, and pharmacy services, along with clinical expertise, research, operations, and advanced technology to help care work better, together.

Among us are care providers, engineers, data scientists, and other dedicated professionals determined to recover, eliminate and prevent unnecessary medical-expenditure spending.

The Business Analyst II will be responsible for translating basic business needs into application software requirements.

• Analyzes business needs to determine optimal means of meeting those needs
• Determines specific business application software requirements to address specific business needs
• Works with programming staff to ensure requirements will be incorporated into system design and testing
• Acts as liaison with users of the software to address questions/issues

• Requires a BA/BS and minimum of 3 years related business analysis experience, or any combination of education and experience, which would provide an equivalent background.

• Familiarity with healthcare payer systems, claim lifecycle, and reimbursement methodologies, along with a basic understanding of medical billing guidelines and regulations.
• Exposure to medical coding systems (ICD, CPT, HCPCS) is a plus.
• Strong analytical abilities to review claim data and identify over payment trends, along with a problem‑solving mindset for troubleshooting issues and testing solutions.
• Ability to extract insights from data to support claim validation and recovery accuracy.
• Strong writing skills for provider communications and validation instructions, and the ability to create and maintain policies, manuals, and contracts to support transparency.
• Clear communication with stakeholders to address workflow inquiries.
• Capacity to adapt quickly to evolving tasks, new tools, and process improvements, with the ability to multitask.
• Self‑starter, proactive in supporting recovery operations.
• Work effectively as a liaison between external business partners, vendors, and internal teams.
• Contribute to a culture of continuous improvement within Payment Integrity.
• Knowledge of systems capabilities and business operations is strongly preferred
• For URAC accredited areas, the following professional competencies apply:
  Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills
• If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a sensitive position work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions
• Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions
• Associates in these jobs must follow the specific policies, procedures, guidelines, etc as stated by the Government Business Division in which they are employed

For candidates working in person or virtually in the below location(s), the salary
* range for this specific position is $64,764 to $97,146.

Locations:
Maryland

In addition to your salary, 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).

The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state,