Jobs at Elevance Health

Leads implementation of new and renewing customer accounts for 340B specialty pharmacy benefit plans. Coordinates deliverables across sales, account management, operations, underwriting, and customers; tracks implementation progress; resolves issues; supports RFPs and finalist meetings; develops implementation tools and best practices; and performs root cause analysis and process improvement.

Manages HEDIS audit activities across business lines, coordinating internal teams, health plans, committees, and state or national auditors. Interprets NCQA, CMS, and state requirements; develops audit work plans, assigns resources, oversees quality studies, analyzes quality data, and reports findings and recommendations. The role ensures compliant HEDIS and CAHPS submissions and prepares departments for external audits through mock interviews and ongoing process oversight.

Generates and qualifies sales leads through outbound email, phone, and social outreach. Conducts market research, nurtures prospects, schedules discovery meetings, analyzes campaign performance, and reports pipeline results. The role optimizes lead-generation processes, maintains CRM data quality, collaborates cross-functionally on solutions and launches, and ensures activities follow applicable regulations and best practices.

Leads enterprise workflow modernization and architecture while designing scalable AI solutions, distributed systems, integrations, and digital products. Establishes technical standards, governance, responsible AI practices, and AI-enabled SDLC improvements. Partners with product, design, architecture, security, operations, and business teams to deliver secure, resilient workflow experiences. Provides hands-on technical leadership, mentorship, modernization strategy, and guidance on enterprise AI investments.

Develop and improve corporate tax data platforms, decision-support systems, data models, reporting applications, and data warehouse solutions. Design database tables, analyze tax data sources and flows, address data integrity issues, and program tax systems. Coordinate project activities, monitor schedules and costs, and train users on developed applications. The role requires strong programming and tax system design expertise, with preferred experience in Microsoft Fabric, Python, SQL, Microsoft BI tools, Oracle platforms, and tax data systems.

Leads enterprise AI adoption by evaluating vendors, models, platforms, and emerging technologies; designing reusable agentic frameworks and reference architectures; developing prototypes and proofs of concept; and enabling scalable, secure AI solutions. Partners with business, engineering, security, legal, compliance, and procurement teams to define adoption standards, evaluate tradeoffs, and guide AI investments across cloud, distributed systems, APIs, microservices, and DevOps environments.

Provides enterprise-wide legal counsel on technology matters, including AI, SaaS, software as a medical device, data use, and digital health product development. Negotiates technology agreements, advises sales teams on RFPs, assesses regulatory risks, develops contract templates and negotiation playbooks, and supports risk mitigation, strategic legal analysis, and internal education.

Leads pharmacy-focused Special Investigations Unit activities involving healthcare insurance fraud, waste, and abuse. Reviews cases, analyzes billing and payment data, prepares statistical and financial reports, develops findings and settlement recommendations, trains staff, guides investigators, coordinates with law enforcement and regulators, supports policy development, and represents the company in court proceedings.

Leads process improvement and continuous improvement initiatives for a business unit. Identifies opportunities, researches and implements best practices, develops performance metrics, consults internally, and creates enterprise-wide improvement plans. Requires extensive process improvement, planning, project management, business analysis, and leadership experience, with preferred expertise in PBM claims, SQL, Teradata, Python automation, vendor management, Lean Six Sigma, prior authorization, eligibility, and Salesforce.

Provides telephonic crisis intervention and referral support to individuals seeking behavioral health services. Screens and assesses safety risks, de-escalates callers, develops action plans, documents interactions, coordinates referrals and resources, and conducts follow-up to support access to care. The role operates in a 24/7 call center environment and requires compliance with HIPAA, OSHA, and applicable regulations.

Audits inpatient medical records and claims to validate coding and DRG assignments, identify recoverable claims, and produce audit findings. Applies advanced ICD-10-CM expertise, clinical guidelines, and reimbursement knowledge across MS-DRG, AP-DRG, and APR-DRG. Reviews documentation for coding accuracy, identifies additional recovery opportunities, maintains audit quality standards, and recommends process improvements.

Assists with actuarial rate determination, statistical analysis, pricing, valuation, and forecasting models. Collects, validates, and refines data; applies actuarial tools; and communicates findings and recommendations to colleagues, business partners, and leadership. The role requires a bachelor’s degree and at least one SOA or CAS actuarial exam, with additional exams, analytical programming experience, and healthcare interest preferred.