Teams at Elevance Health

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.

Analyzes, researches, coordinates, and reports on provider data for internal teams, providers, and regulatory agencies. The role generates reports, performs network and file analysis, supports surveys and ad hoc data requests, validates report accuracy, coordinates with stakeholders, and serves as a technical liaison for provider database information. Responsibilities may also include data support, system enhancements, and testing.

Translates complex PBM business needs into software requirements and solutions. Leads analyst teams, conducts claims and business impact analyses, investigates operational issues, performs root cause analysis, evaluates risks, develops remediation recommendations and business cases, and presents findings to leadership. Partners with Operations, Product, Technology, Finance, Compliance, and Client Services to improve processes, strengthen controls, and support PBM operations initiatives, compliance, audits, and contractual obligations.