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Business Analyst II, Business Analyst III or Business Consultant

Anthem, Inc

This is a Contract position in Boston, GA posted November 16, 2021.

Description SHIFT: Day Job SCHEDULE: Full-time Your Talent.

Our Vision.

At Anthem, Inc., its a powerful combination, and the foundation upon which were creating greater access to care for our members, greater value for our customers, and greater health for our communities.

Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America’s leading health care companies and a Fortune Top 50 Company.

Business Analyst II / Business Analyst III or Business Consultant Location: Remote opportunity This is an opportunity to join a growing team of associates within DBG.

Our team is responsible for identifying claims processing issues on WGS through data mining and then creating business requirements documents (BRD) to create data mining queries that will contribute to cost of care savings and total program savings.

These positions will primarily perform WGS tasks in conjunction with the pre-pay initiative project for Datamining and Overpayments (DMO).

Business Analyst II/III Primary duties may include, but are not limited to: Assessing overpayment opportunity by reviewing WGS claim samples.

Accessing provider contracts, company claims policy and coding guidelines to support prevention opportunities.

Partners closely with query data analysists to create queries that will identify overpayments for prevention.

Develops and maintain collaborative relationships with query developers, business owners and partners as well as ROI consultants and analysts.

Manages and prioritizes work assignments based on business needs.

Researches leads to identify additional overpayment savings opportunities.

Identifies and analyzes complex overpayment needs to determine optimal means of meeting those needs.

Determines specific business requirements to address complex business needs.

Develops Business Requirement Documentation and coordinates UAT and PNP documentation, involving those in and outside the business unit.

Works with Query Developers to ensure requirements are included into the query design and testing.

Collaborates, provides direction and guidance to team members and serves as an expert for the team.

Identifies process improvement opportunities that result in increased savings.

Serves as a liaison between the data mining, validation and other business partners.

Business Consultant Primary duties may include, but are not limited to: Takes initiative to discover new prevention opportunities for CoC & TPS savings.

Evaluates overpayment opportunities by identifying and reviewing WGS claim samples.

Researches leads to identify additional prevention savings opportunities.

Researches all business documentation to develop accurate and robust queries.

Analyzes provider contracts, company claims policies and coding guidelines to identify and support prevention opportunities.

Writes Business Requirement Documents (BRD) and demonstrated experience and ability to perform UAT for low to high complexity projects.

Partners closely with Query Developers to ensure business requirements will be incorporated into recovery query design and testing.

Manages projects with clear documentation and follow up.

Facilitates meetings, including meeting preparation and documentation.

Manages and prioritizes work assignments based on business goals.

Coordinates concept expansions, enhancements and UATs as the POC, for concepts.

Identifies process improvement opportunities that result in increased savings.

Consults with business partners concerning processes, procedures, contracts, processing rules and other system rules to identify overpayments.

Provides direction and guidance to analysts and serves as an expert for the team.

Qualifications This position is posted as a job family and the selected candidate will be placed into the job level commensurate with their experience Minimum Requirements: Business Analyst II Requires a BA/BS and minimum of 3 years related business analysis experience, or any combination of education and experience, which would provide an equivalent background.

Business Analyst III Requires a BA/BS and minimum of 5 years business analysis experience, that includes knowledge of systems capabilities and business operations; or any combination of education and experienced, which would provide an equivalent background.


Business Consultant Requires a BA/BS and minimum of 8 years business analysis experience, which should include analysis, project management, working knowledge of mainframe computer, hardware and operating systems; or any combination of education and experience, which would provide an equivalent background.

Ability to travel may be required.

Preferred Qualifications: Commercial claims experience Experience with WGS Advanced skill level with MS Excel, pivot tables, formulas, V-lookup, etc.

Must possess strong analytical and problem-solving skills with research oriented approach; strong written, verbal and interpersonal communication skills are required Ability to manage multiple projects in various stages to completion Demonstrated meeting facilitation skills .

For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills .If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a ‘sensitive position’ work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions.

Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions.

Associates in these jobs must follow the specific policies, procedures, guidelines, etc.

as stated by the Government Business Division in which they are employed.

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.

An Equal Opportunity Employer/Disability/Veteran.

Anthem, Inc.

has been named as a Fortune 100 Best Companies to Work For, is ranked as one of the 2020 Worlds Most Admired Companies among health insurers by Fortune magazine, and a 2020 Americas Best Employers for Diversity by Forbes.

To learn more about our company and apply, please visit us at

An Equal Opportunity Employer/Disability/Veteran.

Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

REQNUMBER: PS62347-Nevada