Jobs at Elevance Health

Manage a team of clinical and non-clinical staff overseeing post-physician-review workflows, complex escalations, authorizations, appeals, and care coordination. Ensure adherence to medical policy and benefits, partner with physicians and cross-functional teams to remove barriers, improve workflows, and drive timely, high-quality outcomes for providers and members.

Support strategic sales and account teams to grow and retain accounts by building client and broker relationships, resolving routine sales/claims/benefit issues, conducting client meetings to drive upsells, coordinating RFP responses, maintaining sales/proposal system updates, and supporting reporting and internal stakeholder collaboration.

Analyze complex business metrics, create and maintain databases and reports (periodic and ad hoc), use statistical methods to summarize performance, identify anomalies, and recommend data-driven actions. Collaborate with stakeholders to define KPIs and translate business requirements into decision-support tools.

Write, edit, and advise on marketing and sales communications (proposals, presentations, retention materials) for presale and acquisition/retention. Partner with business and creative teams, ensure legal and brand compliance, assess communication effectiveness, and recommend efficiency and clarity improvements.

Lead end-to-end release planning and coordination for FEP applications across teams and environments. Maintain release calendars, manage cross-team dependencies, surface and mitigate release risks, enforce change and implementation processes, support CAB and go/no-go decisions, and apply lessons learned to improve release discipline and stability.

Perform clinical and claims analysis to identify and investigate potential fraud and abuse. Conduct retrospective claims and medical record reviews, collaborate with SIU and internal teams, recommend interventions, and research healthcare issues to prevent loss.

Lead and execute enterprise strategy projects: identify and prioritize initiatives, manage cross‑functional programs, perform advanced analyses, present recommendations to senior leadership, facilitate large working sessions, and coach teams on continuous improvement and metrics reporting.

Audit paid claims to identify and validate overpayments, recover funds, perform claim adjustments and collections, coordinate benefits/Medicare/policy issues, work cross-functionally with contract managers and other departments, maintain cash application and account balances, and research voluntary refunds.

Audit paid claims to identify and recover overpayments, perform cash application and accounts receivable tasks, research refunds, and coordinate complex issues including Medicare and coordination of benefits. Collaborate with other departments and contract managers, perform collections and maintain accurate account balances.

Manage development, testing, delivery and support of assigned technology systems. Plan and direct resources and timelines, manage an application or portfolio, resolve delivery hurdles, assist budget development, collaborate with stakeholders, hire/train/evaluate direct reports, and perform engineering work during high volume periods.

Researches and evaluates health claims for third-party liability and workers' compensation recovery. Reviews documents, analyzes relatedness and reimbursement amounts, applies plan language and law, prepares case files, coordinates payments, negotiates settlements within authority, and responds to recovery inquiries.

Senior HR strategic advisor partnering with C-suite to shape workforce strategy, organizational design, leadership capability, and culture. Leads enterprise workforce planning, predictive analytics, large-scale change initiatives, cross-functional HR alignment, executive coaching, and measurement of talent program ROI to drive organizational performance and resilience.

Provide telephonic crisis intervention and de-escalation, screen and assess callers, develop and monitor care plans, coordinate internal/external resources, support non-clinical call takers, lead shifts in manager absence, monitor call volumes and staff availability, and participate in cross-functional projects to improve operations and member outcomes.

Support capitation configuration and policy implementation for health plans. Translate business needs into application requirements, test implementations, analyze provider payments/contracts, perform data and trend analysis, and collaborate with cross-functional teams to resolve provider questions and system issues.

Serve as liaison between business and IT to define requirements, validate pharmacy benefits systems (formulary, utilization management) using claims/query testing, identify/triage defects, coordinate cross-functional teams, develop project plans, guide testing and automation, and support users and stakeholders throughout implementation.

Serve as liaison between IT and business to lead end-to-end UAT: translate requirements into UAT plans and test cases, run SQL for data validation, coordinate cross-functional testing, lead defect triage, drive stakeholder alignment, provide training and testing metrics, and co-manage UAT cycle with IT QA.

Perform and supervise complex Medicare cost report desk reviews and audits, prepare work papers per Government Auditing Standards and CMS requirements, analyze reimbursement data, handle appeals and exception requests, mentor junior staff, participate in special projects, and support CMS contractual workload with occasional travel and required training.

Review paid claims to identify and validate overpayments, calculate amounts, process refunds and claim adjustments, research voluntary refunds, balance accounts, perform collection activities, and collaborate with internal teams to maintain cash application and accounts receivable accuracy.

Support pricing strategies and rating model development for individual and small-employer commercial markets. Build and maintain actuarial models, analyze and forecast risk/data, coordinate special pricing projects, and prepare regulatory rate filings with internal teams and state/federal agencies.

Validate paid claims for overpayments, calculate and process refunds, research voluntary refunds, balance accounts, perform collections and cash application tasks, and collaborate with internal teams to resolve routine claim and payment issues.