Benefits Analyst III - Benefit Validation/Audit SME
Elevance Health

Atlanta, Georgia

This job has expired.


Description

Benefits Analyst III - Benefit Validation/Audit SME

Location : This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.

The Benefits Analyst III - Benefit Validation/Audit SME is responsible for identifying complex business needs and translates the needs into application software requirements in support of operations, productions, and projects.

How you will make an impact:

  • Designs and builds new complex non-standard benefit plans, reviews and analyze benefit summaries and identifies best approach to code/develop benefits to achieve optimum adjudication levels.
  • Maintains avoidance to negative financial, regulatory, and operational impact.
  • Performs testing and quality assurance of new product developed.
  • Research and analysis of RFP proposals, and product projects.
  • Create and maintain issue log on appropriate tool, resolve defects based on knowledge and analysis of system functionality.
  • Researches and responds to complex inquiries from various departments.
  • May consult with and mentoring of less experienced team members.
  • Serves as trainer for standard and highly customized benefit configuration.
  • Represents department in production related meetings including product development, design and implementation.
  • Must be able to perform all duties of lower-level positions as directed by management.
Minimum Requirements:

Requires a BA/BS in a related field and minimum of 3 years experience in claims processing, previous medical health care, analytical experience, or project management experience, or 5 years of benefit coding experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences :
  • Healthcare insurance and US medical benefits experience strongly preferred.
  • Benefit Coding audit experience strongly preferred.
  • Experience using SPIDER highly preferred.
  • Experience using WGS claims system highly preferred.
  • Experience interacting confidently with key stakeholders, as a subject matter expert and comfortable with providing information as requested.
  • High Proficiency in Microsoft Excel spreadsheets and navigating computer applications preferred.
  • Ability to work independently and assume responsibility for the completion of special projects in a timely manner required.
  • Excellent communications skills (written and verbal) and interpersonal skills.
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $66,400 to $109,560

Locations: California; Colorado; Nevada; Washington State; Jersey City, NJ; New York City, NY; Ithaca, NY and Westchester County, NY

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, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

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.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Elevance Health approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. 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 ability@icareerhelp.com for assistance.


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