Business Claims Analyst II - Wellpoint Federal

• 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.

• BA/BS and minimum of 3 years related business analysis experience, or any combination of education and experience, which would provide an equivalent background.
• This position is part of our Wellpoint Federal division which, per CMS TDL 190275, requires foreign national applicants meet the residency requirement of living in the United States at least three of the past five years .

• Minimum of two (2) years of experience working within a Claims Operations environment highly preferred
• Prior experience supporting Medicare Fee-for-Service (FFS) claims processing strongly preferred.
• Demonstrated understanding of Part A and/or Part B claims workflows, including regulatory requirements, CMS guidance, and CR/TDL implementation processes.
• Experience responding to external audits, CMS inquiries, compliance requests, and cross-functional operational initiatives.
• Proven ability to identify process improvement opportunities and drive standardization across teams.
• Experience developing or maintaining SOPs, job aids, and centralized documentation repositories.
• Strong collaboration skills with the ability to work across operational areas (e.g., Clinical Claims, Appeals, Provider Enrollment, EDI, Contact Centers, and other business partners).
• Ability to analyze operational trends, recommend solutions, and support innovation initiatives within a regulated environment.
• Comfortable working with data (Excel, basic SQL is a plus) and using tools like Power BI to review and share insights
• Foundational understanding of AI capabilities in healthcare and how they can support process improvement or reduce manual work

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