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Elevance Health · 5 days ago

Provider Outreach Business Analyst II

KY-LOUISVILLE, 3195 TERRA CROSSINGS BLVD STE 203-204 & 300

Full-time

Hybrid

Mid Level

3+ years exp

Elevance Health is a health company dedicated to improving lives and communities. The Provider Outreach Business Analyst II is responsible for conducting outbound calls to healthcare providers to verify the accuracy of billed services and ensure claims are submitted and processed appropriately.

Health CareHealth InsurancePersonal HealthWellness

H1B Sponsor Likely

Responsibilities

Conduct outbound provider calls to confirm that services were rendered, and that the provider was expecting payment

Review claim details to determine claim validity before initiating outreach, ensuring all required information is accurate and complete

Meet or exceed daily outbound call attempt requirements as established by departmental performance metrics

Maintain a QA (Quality Assurance) score of 95% or higher, demonstrating adherence to process, accuracy in documentation, and professionalism in communication

Meet all Service Level Agreement (SLA) requirements related to outreach, documentation, and productivity

Provide excellent customer service when interacting with providers, addressing questions politely and professionally

Follow Desk Level Procedures (DLPs), workflows, and operational guidelines to ensure consistency and compliance in all outreach activities

Accurately document call outcomes and follow-up activities in required systems

Review and evaluate payment integrity recovery requests from external partners to determine validity and appropriateness

Analyze claim data to confirm recovery eligibility using applicable CPT, HCPCS, and ICD-10 codes

Utilize systems such as Facets and Macess to research claims, validate overpayments, and document findings

Collaborate with internal teams to clarify claim details and ensure accurate communication with partners

Prepare and maintain detailed documentation supporting recovery decisions

Provide recommendations for process improvement and assist with the implementation of corrective actions

Ensure compliance with all internal policies, regulatory requirements, and partner agreements

Qualification

Healthcare claims analysisPayment integrityClaims recoveryFacetsMacessData analysisCustomer serviceProcess improvementAttention to detail

Required

Requires a BA/BS and minimum of 3 years related business analysis experience, or any combination of education and experience, which would provide an equivalent background

Preferred

2–4 years of experience in healthcare claims analysis, payment integrity, or related field strongly preferred

Proficient in Facets, Macess, and Microsoft Office Suite (Excel, Word, Outlook) preferred

Experience in medical claims processing workflows and systems preferred

Experience in payment integrity or claims recovery functions within a health insurance or managed care environment strongly preferred

Prior experience identifying or developing new recovery leads preferred

Familiarity with data analysis or query tools (e.g., SQL, Tableau, or similar) 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

Represents job field similar to this job

Trends of Total Sponsorships

2025 (488)

2024 (604)

2023 (660)

2022 (222)