Business Analyst III- Data Mining Overpayment and Operations/Payment Integrity- WGS Claims
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Anticipated End Date: 2026-07-17 Position Title: Business Analyst III- Data Mining Overpayment and Operations/Payment Integrity- WGS Claims Job Description: Title: Business Analyst III Location: Indianapolis, IN Hybrid T…
Skills: Data Mining, Business Analysis, Payment Integrity, Claims Processing, Advanced Excel
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Business Analyst III- Data Mining Overpayment and Operations/Payment Integrity- WGS Claims
Sign up with Clera and we'll reach out the moment a role actually fits you — no more spraying applications into the void.
Full-time
bachelor degree
Merit Increases, Paid Holidays, Paid Time Off, Incentive Bonus Programs, Medical Insurance, Dental Insurance
Posted 33d ago
Apply by Jul 17
~40 hrs/week
Responsibilities
Acts as a liaison between business and IT to translate complex needs into requirements for machine learning models and data mining queries. Analyzes claims data to identify overpayment risks, trends, and opportunities for cost of care savings.
Requirements
Requires a BA/BS degree and a minimum of 5 years of business analysis experience. Preferred qualifications include expertise in payment integrity, recovery operations, and advanced Excel skills.
Full job description
Anticipated End Date:
2026-07-17
Position Title:
Business Analyst III- Data Mining Overpayment and Operations/Payment Integrity- WGS Claims
Job Description:
Title: Business Analyst III
Location: Indianapolis, IN
Hybrid 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.
Shift: Monday – Friday Daytime Hours
As a part of the Data Mining Overpayment and Operations team, the Business Analyst III is responsible for serving as the liaison between business and IT in translating complex business needs into businesscases or business requirements documents (BRD) to create machine learning models or data mining queries that will contribute to cost of care savings.
How you will make an impact:
Primary duties may include, but are not limited to:
Analyzes complex claims data including identifying trends, overpayment risks, and opportunities for prevention.
Identifies areas at risk and make recommendations on how to minimize the risk.
Consults with business partners concerning processes, procedures, contracts, processing rules and other system rules.
Performs analysis of structured and unstructured data to identify trends, solve complex business problems, and support overpayment detection using automation/AI tools.
Collaborates with cross-functional teams to identify process gaps and recommend solutions that minimize risk and improve overpayment prevention and recovery outcomes.
Works with business partners to ensure solutions are in place for leakage around automation and testing to validate potential overpayments.
Acts as a resource and consultant to users and business partners, addressing questions related to systems, processes, procedures, and implementation of technology.
May provide direction and guidance to team members, lead efforts on complex projects, and serve as a subject matter expert for the team.
Minimum Requirements:
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. Knowledge of systems capabilities and business operations is strongly preferred.
Preferred Skills, Capabilities and Experiences:
Knowledge of systems capabilities and business operations is strongly preferred.
Experience in payment integrity or recovery operations, including leakage analysis.
Knowledge of WGS, pricing outcomes, and recovery/concept tools (e.g., PICM, ECM, ACR).
Strong data analysis skills with ability to quantify trends and financial impact.
Advanced Excel skills (pivots, formulas, VLOOKUPs, Power Query).
Ability to communicate insights and partner to resolve process and automation gaps.
Claims processing skills
Job Level:
Non-Management Exempt
Workshift:
Job Family:
BSP > Business Support
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.
Who We Are
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 are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
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 should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. 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.
NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13.
Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner.
Our nearly 100,000 associates serve more than 118 million people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health.
We believe that improving health for everyone is possible. It begins by redefining health, reimagining the health system, and strengthening our communities.
Offices: 220 Virginia Ave, Indianapolis, Indiana 46204, US
Health CareWellnessHealth InsurancePersonal Health
How much do Technology jobs in Indianapolis, IN pay?
Based on 358 listings with disclosed salaries, most technology jobs in Indianapolis, IN pay between $66k–$197k per year. Individual offers vary with seniority, company size, and specialization.
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