Provider Claims Recovery Analyst II - Hybrid

Elevance Health; Indianapolis (IN); Hybrid; USD 65,000 - 85,000; Full time

Job summary

Elevance Health is seeking a Provider Outreach Business Analyst II in a hybrid Indianapolis role. You will assess recovery requests, verify claim validity, and identify opportunities for new recovery leads while maintaining high QA and SLA standards.

You will conduct outbound calls to providers, review claim details, and document outcomes in the systems. Strong claims knowledge and proficiency with Facets/Macess are preferred.

Qualifications

• Requires a BA/BS and at least 3 years of business analysis experience.
• Healthcare claims analysis or payment integrity experience preferred.
• Familiar with Facets and Macess systems.
• Experience supporting payment integrity or claims recovery in health insurance preferred.

Responsibilities

• Conduct outbound provider calls to confirm that services were rendered and that payment was expected.
• Review claim details to determine validity before outreach.
• Meet or exceed daily outbound call targets as per metrics.
• Maintain a QA score of 95%+ and adhere to SLAs.
• Document call outcomes and follow-up activities in required systems.
• Analyze claim data to determine recovery eligibility using CPT, HCPCS, ICD-10 codes.
• Collaborate with internal teams to clarify claim details and ensure accurate communication with partners.
• Provide recommendations for process improvements and assist with corrective actions.

Skills

Business analysis

Claims knowledge

Data analysis

SQL

Tableau

Excel

Communication

Education

BA/BS

Tools

Facets

Macess

Microsoft Office

Job description

Elevance Health is seeking a Provider Outreach Business Analyst II in a hybrid Indianapolis role. You will assess recovery requests, verify claim validity, and identify opportunities for new recovery leads while maintaining high QA and SLA standards.

You will conduct outbound calls to providers, review claim details, and document outcomes in the systems. Strong claims knowledge and proficiency with Facets/Macess are preferred.