Manager Process Improvement - Payment Integrity

Manager Process Improvement - Payment Integrity

Location : It is highly preferred that the selected candidate resides in one of the following cities / states : Chicago, IL; Miami, FL; Tampa, FL; Atlanta, GA; Indianapolis, IN; Nashville, TN; Grand Prairie, TX. Hybrid 2 : This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid / virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The Manager Process Improvement is responsible for building and leading a team that delivers advanced trend and anomaly analytics and translates Payment Integrity insights into meaningful provider and market-level action, with the overall goal of increasing medical savings and improving payment accuracy. Primary duties may include, but are not limited to :

• Oversees a team responsible for engaging the provider community using data-driven insights to support improved post-pay Payment Integrity outcomes, provider behavior change, and audit effectiveness.
• Partners closely with Payment Integrity audit, analytics, operations, and market leadership to prioritize opportunities, guide provider engagement strategies, and align actions with enterprise Payment Integrity objectives.
• Proactively identifies opportunities for improvement.
• Researches, develops, and implements related best practices.
• Develops metrics to track performance and goal achievement; serves as internal consultant relative to continuous improvement initiatives.
• Provides strategic oversight of provider-level analysis aligned by market and state, identifying emerging trends, utilization patterns, and anomalies by extending analytic thresholds and exploring non-obvious patterns within complex claims data.
• Accountable for team development, performance management, and ensuring consistent, high-quality delivery of analytics-informed provider engagement that supports recovery optimization, compliance, and sustainable medical savings.

Minimum Requirements : Requires a BA / BS in a related field and minimum of 5 years management experience with process improvement, project / program management, process engineering and / or performance improvement initiatives; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities & Experience :

Location : Illinois In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient / member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.