Business Consultant - Carelon Integrity

Anticipated End Date:

Business Consultant - Carelon Payment Integrity

Business Consultant - Carelon Payment Integrity

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 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 is a member of our Carelon Payment Integrity’s Data Mining Team
, where we utilize advanced analytics to uncover anomalies and drive real savings. This position plays a critical role in uncovering claims over payments and guiding clients through implementation of data‑driven insights. This individual will be data mining, finding anomalies and validating our findings for external clients.

• May lead teams of analysts assigned to complex projects.
• Determines specific business application software requirements to address complex and varied business needs.
• Analyzes and designs solutions to address complex and varied business needs.
• Consults with business partners concerning application and implementation of technology.
• Lead client consultations to identify and resolve payment integrity issues.
• Analyze complex claim scenarios and business rules to uncover over payments.
• Guide cross‑functional teams through the development and implementation of recovery strategies.
• Design business solutions to address diverse client requirements.
• Partner with query developers to refine logic based on client data and operational feedback.
• Facilitate internal and external meetings, ensuring alignment across stakeholders.
• Document findings, track projects, and manage timelines to successful delivery.

Requires a BA/BS and minimum of 8 years business analysis experience, which should include analysis and project management; or any combination of education and experience which would provide an equivalent background.

• Prior experience in healthcare claims, payment integrity, or consulting highly preferred.
• Strong understanding of claims processing, coding practices, reimbursement policies, and payer‑provider contracting preferred.
• Demonstrated ability to work directly with clients and build long‑term relationships preferred.
• Advanced MS Excel capabilities required (pivot tables, VLOOKUP, formulas) highly preferred.
• Experience leading projects and managing cross‑functional stakeholders preferred.
• Coding certification (e.g., CPC) is strongly preferred.
• Strong verbal and written communication skills are highly preferred.
• Ability to translate technical findings into actionable business strategies preferred.
• Experience with client/vendor relations, customer service, or healthcare analytics a plus.

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.

Job Level:

Non‑Management Exempt

Workshift:

1st Shift (United States of America)

Job Family:

BSP >
Business Support

Please be advised that…