Job Description
Process Improvement Manager - 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. This approach combines structured office engagement with the flexibility of virtual work, promoting a dynamic and adaptable workplace.
The Process Improvement Manager plays a critical role in leading a team that delivers important insights through advanced trend and anomaly analytics. The objective is to enhance Payment Integrity processes, ultimately increasing medical savings and improving payment accuracy.
Key Responsibilities:
• Lead a team focused on engaging the provider community with data-driven insights to enhance post-pay Payment Integrity outcomes and audit effectiveness.
• Collaborate closely with audit, analytics, operations, and market leadership to prioritize initiatives and align strategies with Payment Integrity objectives.
• Identify opportunities for process improvement proactively.
• Develop and implement best practices based on research and analysis.
• Create metrics for tracking performance and goal achievement; serve as an internal consultant on continuous improvement initiatives.
• Provide strategic oversight of provider-level analyses, identifying trends and anomalies through in-depth claims data analysis.
• Ensure team development and performance management while guaranteeing high-quality delivery of analytics-informed provider engagement to support recovery optimization and compliance.
Minimum Requirements: BA/BS in a related field and a minimum of 5 years of management experience in process improvement, project management, or performance initiatives; or a combination of education and experience providing equivalent background.
Preferred Skills and Experience:
• 5 years of experience in healthcare analytics, payment integrity, provider performance, operations, or related functions.
• Experience in using data analysis to identify anomalies and opportunities for medical savings.
• Proven ability to collaborate with operations, product, and technology teams to enhance and streamline workflows.
• Expertise in working cross-functionally to modernize processes through automation, improving efficiency and impact.
• Six Sigma Black Belt or related process improvement certification preferred.
For candidates working in person or virtually, the salary range for this position is $106,832 to $160,248.
Location: Illinois
Elevance Health offers a comprehensive benefits package, including incentive programs and a 401(k) contribution. The salary is based on various factors including location, experience, and education.
Please note that Elevance Health only accepts resumes from agencies with a signed agreement. Unsolicited resumes are considered the property of Elevance Health.
About Elevance Health: We are a Fortune 25 company dedicated to improving lives and communities through simpler healthcare solutions. We seek passionate leaders who can make a significant impact on our members and communities.
Our Culture: Elevance Health creates a culture that prioritizes strategy advancement as well as personal and professional growth for associates. Our values and behaviors drive our success in meeting business outcomes and community needs.
We are committed to the health and safety of our associates and require new candidates in certain roles to be vaccinated against COVID-19 and Influenza. Requests for accommodations will be evaluated in compliance with applicable laws.
Elevance Health is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to protected status. If you require accommodation during the application process, please reach out for assistance.
We encourage applicants with arrest or conviction records, and those impacted by legislation related to fair chance employment, to apply.
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. This approach combines structured office engagement with the flexibility of virtual work, promoting a dynamic and adaptable workplace.
The Process Improvement Manager plays a critical role in leading a team that delivers important insights through advanced trend and anomaly analytics. The objective is to enhance Payment Integrity processes, ultimately increasing medical savings and improving payment accuracy.
Key Responsibilities:
• Lead a team focused on engaging the provider community with data-driven insights to enhance post-pay Payment Integrity outcomes and audit effectiveness.
• Collaborate closely with audit, analytics, operations, and market leadership to prioritize initiatives and align strategies with Payment Integrity objectives.
• Identify opportunities for process improvement proactively.
• Develop and implement best practices based on research and analysis.
• Create metrics for tracking performance and goal achievement; serve as an internal consultant on continuous improvement initiatives.
• Provide strategic oversight of provider-level analyses, identifying trends and anomalies through in-depth claims data analysis.
• Ensure team development and performance management while guaranteeing high-quality delivery of analytics-informed provider engagement to support recovery optimization and compliance.
Minimum Requirements: BA/BS in a related field and a minimum of 5 years of management experience in process improvement, project management, or performance initiatives; or a combination of education and experience providing equivalent background.
Preferred Skills and Experience:
• 5 years of experience in healthcare analytics, payment integrity, provider performance, operations, or related functions.
• Experience in using data analysis to identify anomalies and opportunities for medical savings.
• Proven ability to collaborate with operations, product, and technology teams to enhance and streamline workflows.
• Expertise in working cross-functionally to modernize processes through automation, improving efficiency and impact.
• Six Sigma Black Belt or related process improvement certification preferred.
For candidates working in person or virtually, the salary range for this position is $106,832 to $160,248.
Location: Illinois
Elevance Health offers a comprehensive benefits package, including incentive programs and a 401(k) contribution. The salary is based on various factors including location, experience, and education.
Please note that Elevance Health only accepts resumes from agencies with a signed agreement. Unsolicited resumes are considered the property of Elevance Health.
About Elevance Health: We are a Fortune 25 company dedicated to improving lives and communities through simpler healthcare solutions. We seek passionate leaders who can make a significant impact on our members and communities.
Our Culture: Elevance Health creates a culture that prioritizes strategy advancement as well as personal and professional growth for associates. Our values and behaviors drive our success in meeting business outcomes and community needs.
We are committed to the health and safety of our associates and require new candidates in certain roles to be vaccinated against COVID-19 and Influenza. Requests for accommodations will be evaluated in compliance with applicable laws.
Elevance Health is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to protected status. If you require accommodation during the application process, please reach out for assistance.
We encourage applicants with arrest or conviction records, and those impacted by legislation related to fair chance employment, to apply.
💡 Quick Summary
Seeking a career-building opportunity? The Process Improvement Manager - Payment Integrity position is now open for candidates interested in the Operations Executive Jobs sector. This role in Atlanta offers a professional environment and growth potential.
Requirement Snapshot: Candidates should possess basic communication skills, a proactive attitude, and the ability to work in a team. Experience in Operations Executive Jobs is a plus.