Job Description

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.

• 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 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 overpayment opportunities that will contribute to cost of care savings and total program savings

How you will make an impact:

• 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 overpayment.

• 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 overpayment model development.

• Complex data mining analysis and coordinating the activities of a project team.

Minimum Requirements:

• 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.

Preferred Skills and Abilities:

• 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.

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 passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require 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.

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 [email protected] 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.

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