Jobs at Elevance Health

Lead architecture, development, and deployment of large-scale, production AI systems (LLMs/agentic systems). Define enterprise AI architecture, modernize legacy systems, implement AI-enabled SDLC and DevOps practices, establish governance and responsible AI, and provide technical leadership and mentorship across engineering teams.

Senior analytics role identifying and explaining healthcare trend drivers. Leads complex analyses, develops dashboards and actuarial pricing/valuation, mentors junior analysts, and promotes AI, automation, and visualization adoption to inform business decisions and risk management.

Provide high-level administrative support including research and data verification, budget tracking, database creation and analysis, project support and scheduling, correspondence preparation, meeting coordination and minutes, travel arrangements and expense reporting, and phone screening/handling.

Lead analysis of highly complex business needs and translate them into application software requirements. Mentor and provide expertise to lower-level consultants, design solutions, and may lead analyst teams on high-impact projects. Coordinate project management activities, apply mainframe and systems knowledge, and travel to worksites as needed (up to 20%).

Provide telephonic care management for members with complex/chronic needs: assess, develop, implement, coordinate, monitor and evaluate individualized care plans, handle discharge planning, facilitate authorizations/referrals, coordinate resources, interface with Medical Directors, and assist with reimbursement negotiations and provider/claims problem solving.

Provide telephonic care management for members with complex and chronic needs: assess, develop, implement, coordinate, monitor, and evaluate care plans; facilitate authorizations/referrals; coordinate resources; support discharge planning and interface with medical leaders.

Provide telephonic care management for members with complex/chronic needs: assess, develop, implement, coordinate and monitor individualized care plans; facilitate authorizations/referrals; coordinate resources; interface with Medical Directors and providers; negotiate reimbursement rates and assist with provider, claims, or service issue resolution.

Coordinate precertification and prior authorization reviews, manage inbound calls and post-service claims, verify benefits and eligibility, enter referrals into the UM system, authorize initial sessions, escalate clinical cases to nurse reviewers, and maintain timely, professional communication with providers and internal teams while multitasking across digital channels.

Handle incoming calls and post-service claims, verify eligibility and benefits, authorize admissions/precertifications/prior authorizations, collect intake data, refer clinical cases to nurse reviewers, and liaise with providers and internal teams.

Analyze and report HEDIS and other healthcare data, maintain databases, develop performance reports and ad hoc analyses, identify anomalies, and translate business needs into decision-support tools.

Lead clinical pharmacy strategy, program development, implementation, and oversight across customer segments. Drive pharmacy trend analysis, reporting, client mandate execution, and cross-functional initiatives to improve medication adherence, clinical outcomes, and cost of care. Manage budget, support accreditation, contribute to RFPs and business growth, and hire, develop, and evaluate pharmacy teams.

Apply advanced analytics to drive program design, member targeting, predictive modeling, and measurement of clinical, utilization, and financial outcomes. Consult with business and clinical leaders, lead applied research, develop evaluation methodologies, and communicate insights via white papers and presentations.

Designs and executes complex data mining and extraction programs, writes queries and reports, develops data-warehouse-based reports and applications, maintains data warehouse knowledge and integrity, and provides training on developed applications.

Verify and document patient insurance coverage for medical and pharmacy benefits, coordinate benefits and authorizations, run test claims, support prior authorizations and financial assistance enrollment, communicate coverage and next steps to patients, and collaborate with pharmacy teams to ensure timely medication access while maintaining compliance and documentation.

Translate business needs into application software requirements for healthcare claims and billing processes. Analyze requirements, liaise with users and programmers, support system design and testing, and manage multiple projects with emphasis on claims processing, medical coding, and billing validations.

Review, analyze and process non-complex pre- and post-service grievances and appeals in compliance with regulatory and accreditation standards. Research claims and medical records, route clinical issues to medical staff, render determinations, and prepare clear written communications. Serve as liaison with medical management, legal, and operations as needed. Follow department guidelines and URAC/NCQA requirements.

Lead and manage subrogation and recovery operations across multiple units and states. Develop strategy, policies, and internal controls; analyze operational and financial data; ensure regulatory compliance; resolve complex issues with internal and external stakeholders; and recruit, train, coach, and evaluate staff to optimize departmental effectiveness and cost recovery.

Serve as liaison between Provider Solutions, Health Economics, and Contract Admin to translate complex business needs into software requirements, reports, and tools. Lead analysts on projects, design solutions, develop project plans, manage resources, execute recovery workflows for contract compliance and chargemaster variances, and review/interpret complex contracts to support reimbursement decisions.

Support actuarial rate setting by collecting and validating data, performing preliminary actuarial and statistical analyses, updating pricing/valuation/forecasting models, and assisting with actuarial experience reports and audit support under limited supervision.

Serve as a business/systems analyst for Medicaid ESRD/Risk Adjustment programs. Define system requirements, create and run feature tests, develop use cases, partner with technical and business stakeholders, mentor/train staff, estimate application enhancements, and identify system improvement opportunities.