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Elevance Health · 17 hours ago

Provider Contract/Cost of Care Consultant Senior

Indianapolis, IN

Contract

Hybrid

Senior Level

7+ years exp

Elevance Health is a health company dedicated to improving lives and communities. The Provider Contract/Cost of Care Consultant Senior provides high-level analytical support to the Cost of Care and Provider Contracting organizations, focusing on lowering claims costs and improving care quality while leading large-scale initiatives and supporting contract negotiations.

Health CareHealth InsurancePersonal HealthWellness

H1B Sponsor Likely

Responsibilities

Focuses efforts on lowering claims costs, improving the quality of care, and increasing member and provider network satisfaction

Provides expert advice, analytic and consultative support to Medical Directors and management on cost of care issues

Leads large scale initiatives with high dollar cost savings opportunities

Partners with provider contractors to develop contracting strategy and supports all aspects of the contract negotiation process

Works with multiple provider types including the most complex, high-profile providers

Supports a full range of contract arrangements and pricing mechanisms including the most complex contract terms

Works on the most complex, large scale enterprise-wide initiatives and acts as project lead

Acts as a strategic partner to management

Uses analytic tools to track both health risks and compliance, as well as supporting the contract negotiation process

Performs sophisticated retrospective data analytics

Develops the most complex new models and modifies existing models to create predictive impact decision making tools

Performs healthcare cost analysis to identify strategies to control costs

Projects cost increases in medical services by using analytic techniques for PMPM trending via multiple variable analysis

Prepares complex pre-negotiation analyses to support development of defensible pricing strategies

Performs modeling to compare various contract scenarios based on member utilization patterns and 'what if'

Researches the financial profitability/stability and competitive environment of providers to determine impact of proposed rates and projects different cost of savings targets based upon various analytics

Identifies cost of care savings opportunities by analyzing practice patterns in relation to office visits, referral practices, and specialty care procedures and recommends policy changes and claim's system changes to pursue cost savings

Reviews results post-implementation to ensure projected cost savings are realized and recommends modifications as applicable

Recommends standardized practices to optimize cost of care

Educates provider contractors on contracting analytics from a financial impact perspective

Recommends alternative contract language and may go on-site to provider premises during contract negotiations

Researches provider's financial profitability/stability and competitive environment to determine impact of proposed rates

Communicates fee strategies to manage provider expectations

Provides on-going analytic and consultative support during complex and the most intense provider negotiations

Educates provider contractors on contracting analytics from a financial impact perspective

Acts as a source of direction, training and guidance for less experienced staff

Qualification

Statistical analysisCost of care analysisData manipulation toolsProvider contract knowledgeLeadership experienceAnalytical skillsMedicare experienceOrganizational skillsPresentation skillsProblem-solving skills

Required

BA/BS degree in Mathematics, Statistics or related field

Minimum of 7 years of experience in broad-based analytical, managed care payor or provider environment

In depth experience in statistical analysis and modeling

Preferred

Master's degree preferred

Experience providing leadership in evaluating and analyzing complex initiatives preferred

Cost of care analysis knowledge preferred

Proficiency in data manipulation tools such as SQL, SAS, or similar preferred

Exceptional analytical, organizational, presentation, and problem-solving skills preferred

Provider contract knowledge preferred

Medicare Group Retiree experience preferred

Benefits

Merit increases

Paid holidays

Paid Time Off

Incentive bonus programs

Medical

Dental

Vision

Short and long term disability benefits

401(k) +match

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)