Elevance Health · 20 hours ago
Payment Integrity Business Analyst III
Norfolk, VA
Full-time
Hybrid
Senior Level
5+ years expElevance Health is a health company dedicated to improving lives and communities. The Payment Integrity Business Analyst III is responsible for analyzing payment integrity recovery requests, assessing their validity, and identifying opportunities for new recovery leads, while serving as a liaison between business and IT.
Health CareHealth InsurancePersonal HealthWellness
Responsibilities
Analyzes complex end user needs to determine optimal means of meeting those needs
Determines specific business application software requirements to address complex business needs
Develops project plans and identifies and coordinates resources, involving those outside the unit
Works with programming staff to ensure requirements will be incorporated into system design and testing
Acts as a resource to users of the software to address questions/issues
May provide direction and guidance to team members and serves as an expert for the team
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
Apply claims processing knowledge to identify patterns or issues that may lead to new recovery opportunities
Leverage external and internal resources such as the CMS website, State Medicaid websites, and the Knowledge Library to validate recovery requests and ensure regulatory accuracy
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
Required
Requires a BA/BS and minimum of 5 years business analysis experience; or any combination of education and experience which would provide an equivalent background
Analyzes complex end user needs to determine optimal means of meeting those needs
Determines specific business application software requirements to address complex business needs
Develops project plans and identifies and coordinates resources, involving those outside the unit
Works with programming staff to ensure requirements will be incorporated into system design and testing
Acts as a resource to users of the software to address questions/issues
May provide direction and guidance to team members and serves as an expert for the team
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
Apply claims processing knowledge to identify patterns or issues that may lead to new recovery opportunities
Leverage external and internal resources such as the CMS website, State Medicaid websites, and the Knowledge Library to validate recovery requests and ensure regulatory accuracy
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
Preferred
2–4 years of experience in healthcare claims analysis, payment integrity, claims recovery functions or related field strongly preferred
3-5 years claims adjusting experience
Proficient in Facets, Macess, and Microsoft Office Suite (Excel, Word, Outlook) preferred
Working knowledge of CPT, HCPCS, and ICD-10 coding, medical claims processing workflows and systems preferred
Experience demonstrating analytical, critical thinking, and problem-solving skills preferred
Prior experience identifying or developing new recovery lead preferred
Experience with data analysis or query tools (e.g., SQL, Tableau, or similar) preferred
Experience with strong attention to detail and ability to manage multiple tasks in a fast-paced environment preferred
Effective verbal and written communication skills preferred
Experience in daily performance metrics and turnaround expectations environment 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
Elevance Health is an integrated whole-health approach to help people in health journey and address their full range of needs.
10001+ employees
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)
Funding
Current Stage
Public CompanyTotal Funding
unknown2001-10-30IPO
Leadership Team
Gail K. Boudreaux
President and CEO
Geeta Wilson
Chief Technology Officer (CTO): Digital Health and Service Experience Platforms
Recent News
Yahoo Finance
2026-01-09
2026-01-06
Company data provided by crunchbase