Financial Operations Analyst Lead- Data Mining Overpayment and Operations/Payment Integrity- WGS Claims

Anticipated End Date: 2026-08-06 Position Title: Financial Operations Analyst Lead- Data Mining Overpayment and Operations/Payment Integrity- WGS Claims Job Description: Title : Financial Operations Analyst Lead Hybrid 1: This role requires associates to be in-office 1 - 2  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.   As a part of the Data Mining Overpayment and Operations team, t he Financial Operations Analyst Lead is responsible for analyzing data and providing new processes, system enhancements and technical solutions to complex business issues. Leads and coaches staff. Manages workflow and oversees day-to-day department responsibilities. May conduct operational meetings with staff. Assists management in establishing work goals.   How you will make an impact:   Develops and executes complex data analysis.    Develops strategic report applications from Finance systems.    Provides decision support and procedural input to ensure that processing efficiency does not compromise internal control mechanisms.    Interfaces with IT as needed to document and track any needed system enhancements.    Assists in the implementation of Data Science models within the Finance organization.    Utilizes claims expertise to explain business needs to technical partners .    Represents department in cross functional and executive meetings .    Use s discretion in making independent decisions.    P rovide direction and guidance to team members, lead efforts on complex projects, and serve as a subject matter expert for the team.

Requires a BA/BS in accounting or finance and a minimum of 5 years' experience in a finance/health insurance field capacity and experience with relational databases and mainframe and client server report writers; or any combination of education and experience, which would provide an equivalent background.      Preferred Skills, Capabilities, and Experiences:   Project management experience    Experience working post-pay reviews, validation, and recovery processes in the healthcare industry   Experience managing multiple projects in various stages to completion   Experience with medical billing guidelines, and regulations   Experience with medical coding systems such as ICD, CPT, and HCPCS   WGS claims processing experience   Experience in payment integrity or recovery operations, including leakage analysis   Knowledge of pricing outcomes, and recovery/concept tools (e.g., PICM, ECM, ACR , CI&W ).   Job Level: Non-Management Exempt Workshift: Job Family: AFA > Financial Operations Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

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. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They