Wellpoint Federal SME II

Elevance Health, Inc.; Miami (FL); Hybrid; USD 90,000 - 140,000; Full time

Benefits offered by this job

Hybrid work model

Job summary

Wellpoint Federal, a division of Elevance Health, is seeking a Subject Matter Expert II to support Medicare training programs and content documentation. The role combines in-office collaboration with flexible hybrid work and may require travel to worksite or other locations.

The ideal candidate has 6+ years of Medicare experience, strong knowledge of Medicare A/B, and familiarity with CMS processes. This position emphasizes training design, documentation, and stakeholder collaboration within a

Qualifications

• BA/BS degree and at least 6 years of Medicare experience.
• If assigned to Government Business Division, may be subject to a sensitive position designation and additional requirements.
• Background checks and government clearances may apply; duties segregation, training, monitoring.
• This position is part of Wellpoint Federal division; residency in the United States for the past 3 years may be required for foreign nationals.

Responsibilities

• Research, review, and validate Medicare training materials for accuracy and completeness.
• Assist with analyzing needs and identifying root causes; support CMS-related initiatives.
• Develop and maintain training materials and documentation.
• Keep knowledge up-to-date on Medicare policies and procedures.
• Research newly deployed Medicare regulations and provide impact summaries.
• Design new and enhanced training programs and documentation.
• Assess training outcomes and deliver train-the-trainer sessions.
• Recommend content improvements to management.
• Engage in meetings with primary contractor and CMS as needed.
• Liaise with primary contractor associates and manage day-to-day interactions.
• Assist with process re-engineering and project work.
• Act as a high-level Medicare expert in 2–3+ lines of business.
• Travel to worksite and other locations as necessary.

Skills

Medicare knowledge

Claims knowledge

Project management

Education

BA/BS degree

Job description

Wellpoint Federal SME II

Hybrid 1: 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 accommodation is granted as required by law.

Wellpoint Federal, a subsidiary of Elevance Health, brings deep industry expertise and healthcare service capabilities to support federal programs. The organization delivers solutions across claims administration, data, and care delivery to help address complex challenges and improve health outcomes for federal populations.

The Wellpoint Federal SME II is responsible for providing Subject Matter Expertise for a variety of Medicare Customer Care training programs and content documentation such as scripts and reference materials.

How you will make an impact

Primary duties may include, but are not limited to:

• Researches, reviews, extrapolates, revises and validates training materials and documentation to ensure that they are accurate and complete according to Medicare policies, procedures and related call center technologies.

• Assists Training, Quality and Content team with analyzing and assessing needs and identifying root causes.

• Supports development and maintenance of training materials and documentation.

• Keeps knowledge and expertise current by reviewing Medicare policies, procedures, publications, program materials, etc.

• Researches newly deployed and/or pending Medicare Regulations (e.g. Change Requests and Joint Signature Memorandums: and provides impact summaries to the impacted stakeholders).

• Designs new and enhanced training programs and documentation based on needs.

• Assessments training outcomes and determines if further training or documentation is needed. Supports delivery and/or delivers train-the-trainer sessions.

• Makes recommendations to management on training and content improvements or enhancements.

• As needed, participates in meetings with primary contractor and Centers for Medicare and Medicaid Services (CMS).

• Manages day-to-day interactions and relationships and acts as a liaison with primary contractor associates.

• May assist with process re-engineering and with project work.

• Is a high level Medicare expert in 2-3 or more lines of business.

• Travels to worksite and other locations as necessary.

Minimum Requirements:

• Requires BA/BS degree and a minimum of 6 years of Medicare experience; or any combination of education and experience, which would provide an equivalent background.

• 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.

• This position is part of our Wellpoint Federal division which, per CMS TDL 190275, requires foreign national applicants meet the residency requirement of living in the United States at least three of the past five years.

Preferred Skills, Capabilities and Experiences:

• Strong knowledge of Medicare A and B is highly preferred

• Claims knowledge and understanding is preferred

• Project Management experience is preferred

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 Accessibility Accommodation Request Form https://forms.cloud.microsoft/pages/responsepage.aspx?id=8giMvgesLESaRuvu61vU17EJaA0EP3FIissI8zmZ_NpUNUgyTFRUMkY5NE5JNDFWMkhaUzQxMkJLWS4u&route=shorturl 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.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration https://info.flclearinghouse.com/ .