Business Consultant - Carelon Payment Integrity

Position Overview

Carelon Payment Integrity, a proud member of the Elevance Health family, is seeking a Business Consultant to join its Data Mining Team. In this role you will utilize advanced analytics to uncover claims overpayments and provide data-driven insights that guide clients in recovering, eliminating, and preventing unnecessary medical-expense spending. You will work closely with internal and external stakeholders to lead teams, analyze complex claim scenarios, and design business solutions.

Location: In-office 1-2 days per week with alternate locations considered. Specific office locations include Maryland, Massachusetts, Minnesota, New Jersey, and New York.

Key Responsibilities

• May lead teams of analysts on complex projects.
• Determines specific business application software requirements to address diverse business needs.
• Analyzes and designs solutions to address complex challenges in healthcare claims and payment integrity.
• Consults with business partners regarding the application and implementation of technology.
• Leads client consultations to identify and resolve payment integrity issues.
• Analyzes complex claim scenarios and business rules to uncover overpayments.
• Guides cross-functional teams through the development and implementation of recovery strategies.
• Designs business solutions tailored to diverse client requirements.
• Partners with query developers to refine logic based on client data and operational feedback.
• Facilitates internal and external meetings to ensure stakeholder alignment.
• Documents findings, tracks projects, and manages timelines to successful delivery.

Required Qualifications

• Education: BA/BS or equivalent combination of education and experience.
• Experience Required: Minimum of 8 years in business analysis, including analysis and project management.

Preferred Qualifications

• Prior experience in healthcare claims, payment integrity, or consulting.
• Strong understanding of claims processing, coding practices, reimbursement policies, and payer-provider contracting.
• Demonstrated ability to work directly with clients and build long-term relationships.
• Advanced MS Excel skills, including pivot tables, VLOOKUP, and complex formulas.
• Experience in leading projects and managing cross-functional stakeholders.
• Coding certification (e.g., CPC) is a strong plus.
• Strong verbal and written communication skills with the ability to translate technical findings into actionable business strategies.
• Experience with client/vendor relations, customer service, or healthcare analytics is advantageous.

Benefits & Perks

• Salary: $92,064 to $151,248
• Benefits: Comprehensive benefits package including incentive and recognition programs, equity stock purchase plan, 401(k) contributions, and more (all benefits subject to eligibility requirements).