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Elevance Health · 5 hours ago

Business Consultant - Commercial Claims Data Mining

St Louis, MO

Full-time

Hybrid

Senior Level, Lead/Staff

$92K/yr - $101K/yr

8+ years exp

Elevance Health is a health company dedicated to improving lives and communities. The Business Consultant is responsible for translating business needs into application software requirements and may lead teams of analysts on complex projects.

Health CareHealth InsurancePersonal HealthWellness

H1B Sponsor Likely

Responsibilities

May lead teams of analysts assigned to complex projects

Analyze, design and determines specific business requirements, works directly with Query Developers to ensure requirements will be incorporated into recovery query design and validation

Consults with business partners concerning application and implementation of technology

Consults with business partners concerning processes, procedures, contracts, processing rules and other system rules to create queries that identify Cost of Care and Total Program Savings opportunities

Obtains, interprets and applies provider and member contract language to support the creation of Business Requirement Documents (BRD) that contribute to Cost of Care and Total Program Savings

Writes Business Requirement Documents (BRD) and able to perform Concept Verification for low to high complexity projects

Engage key stakeholders (RAC, Vendors, Provider, COC leads, etc.) and facilitate meetings (agenda, objectives, outcomes, etc.)

Coaches and mentors team members

Effectively communicate defects and/or enhancements to business and/or IT partners

Serves as POC on New Concepts as they are expanded across the Enterprise

Participate in and or lead special projects

Qualification

Business analysisAnalytical skillsWGS Commercial ClaimsProject managementProvider Contract expertiseMeeting facilitationMS ExcelMS WordMS PowerPointCommunication skillsProblem-solving skills

Required

BA/BS and minimum of 8 years business analysis experience, which should include analysis and project management; or any combination of education and experience which would provide an equivalent background

Demonstrated strong analytical and problem-solving skills with research-oriented approach

Ability to manage multiple projects in various stages and complexity levels to completion

Demonstrated meeting facilitation skills

Demonstrated ability to support Commercial States

In-depth knowledge of WGS Commercial Claims processing or adjustments is required

Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills

Project management, ability to manage multiple projects in various stages to completion

Fluent in MS Excel, Word and Power Point

Preferred

Knowledge of systems capabilities and business operations is strongly preferred

In-depth knowledge of WGS Pricing Arrangements is preferred

Provider Contract and Member Benefit expertise – highly preferred

Benefits

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contribution

Merit increases

Paid holidays

Paid Time Off

Incentive bonus programs

Medical

Dental

Vision

Short and long term disability benefits

Stock purchase plan

Life insurance

Wellness programs

Financial education resources

Company

Elevance Health

Glassdoor3.6

Elevance Health is an integrated whole-health approach to help people in health journey and address their full range of needs.

Founded in 1944

Indianapolis, Indiana, USA

10001+ employees

https://www.elevancehealth.com

H1B Sponsorship

Elevance Health has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

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Trends of Total Sponsorships

2025 (488)

2024 (604)

2023 (660)

2022 (222)