Business Consultant Senior

Business Consultant Senior

Location:

Hybrid 1:
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.

• 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 Consultant Senior is responsible for translating most highly complex and varied business needs into application software requirements. These needs typically involve a significant expenditure or cost savings and impact a wide range of functions. Also, provides expertise to lower leveled consultants. This is the highest level in a career progression. This position will be responsible for collaborating with our data science team to develop machine learning models and data mining queries with the purpose of identifying over payment opportunities that will contribute to cost of care savings and total program savings

• Provides expertise to lower level consultants on the analysis of business needs to determine optimal means of meeting those needs.
• Determines specific business application software requirements to address the most highly complex and varied business needs.
• May lead teams of analysts assigned to the most complex projects, typically those of highest importance and impact to the way in which we do business.
• Analyzes and designs solutions to address varied and highly complex business needs.
• Collaborate on automation to validate claims over payment.
• Performs analyses of structured and unstructured data to solve multiple and/or complex business problems, utilizing automation/AI tools and broad knowledge of the organization and/or industry.
• Collaborates with data science providing guidance on over payment model development.
• Complex data mining analysis and coordinating the activities of a project team.

• Requires a BA/BS and minimum of 10 years business analysis experience, which should include analysis, project management, working knowledge of mainframe computer, hardware and operating systems; minimum of 3 years experience as a Business Consultant with project management skills; or any combination of education and experience, which would provide an equivalent background. Travels to worksite and other locations as necessary.

• Excellent verbal and written communication, effective virtual presentation and facilitation skills, research and data analysis experience, advanced skill level with MS Excel – pivot tables, formulas, v-lookup, critical thinking, strong decision-making skills, collaboration skills, and ability to prioritize work.
• Ability to manage multiple projects in various stages to completion and create and deliver executive leadership presentations.
• WGS claims experience
• Knowledge of systems capabilities and business operations is strongly preferred.
• Experience working with large datasets highly preferred.
• PMP certification is highly preferred

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 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 passionate about making an impact on our members and the…