Elevance Health

Pricing Analyst

• Lead cost volume efforts, including pricing strategy, proposal planning and development, and post-submittal activities
• Work with proposal managers to develop and edit proposals and oversee production activities
• Guide teams through proposal pricing strategy for Federal contracts
• Serve as primary liaison for financial strategy
• Direct proposal and capture managers in proposal development and production according to RFP specifications
• Ensure FAR, CAS, government procurement regulations, and RFP compliance
• Coordinate pricing cost narratives, price strategy, risk assessments, and business case analyses
• Lead Price-To-Win assessments and cost and pricing reviews with senior management
• Coordinate collection and accumulation of cost, scheduling, and performance elements
• Research and analyze historical data and develop cost models
• Participate in fact-finding meetings
• Serve as a member of the contract negotiating team
• Provide oversight and direction to pricing specialists
• Travel to worksites and other locations as necessary
• Use approved AI tools for proposal development, RFP analysis, market and competitive research, pricing narratives, cost modeling, and related pricing activities
• Apply human oversight and validation to AI-assisted work products while ensuring data security, confidentiality, procurement, and responsible AI compliance

Pricing Manager

Manager

• Perform care management within the scope of licensure for members with complex and chronic care needs
• Assess, develop, implement, coordinate, monitor, and evaluate care plans across the care continuum
• Perform duties telephonically or on-site, including at hospitals for discharge planning
• Ensure member access to services appropriate to health needs
• Conduct assessments and create care management plans addressing identified objectives and goals
• Facilitate authorizations and referrals within the benefits structure or through extra-contractual arrangements
• Coordinate internal and external resources to meet identified needs
• Monitor and evaluate care plan effectiveness and modify plans as necessary
• Interface with Medical Directors and Physician Advisors on care management treatment plans
• Negotiate reimbursement rates when applicable
• Assist with problem-solving involving providers, claims, or service issues

Nurse Case Manager I

Program Manager

• Manage Ohio Claims for the Medicaid line of business
• Ensure resolution of claims configuration issues, rate changes, compliance, and contractual updates
• Collaborate with claims teams, provider experience, utilization management, regulatory, and call center leads
• Resolve issues involving claims policies, reimbursement policies, authorization codes, and provider complaints
• Deliver regulatory claims reports on time, including Prompt Pay and Claims Disputes reports
• Coordinate development, approval, implementation, and compliance of ongoing external client-facing programs
• Research applicable subject-matter practices and monitor industry trends
• Manage external client-facing relationships and partner with corporate and regional business areas
• Develop program success measures and assess program success periodically
• Oversee the end-to-end claims process, including receipt, adjudication, payment, and reporting on timeliness, accuracy, backlog, and provider payment compliance
• Serve as operational liaison with the state of Ohio, Provider Experience, and internal executive leadership

Program Manager, Ohio Claims

Operations

• Oversee combined digital and operations units and execute strategies for digitized service results
• Lead product-led delivery across claims technology platforms and enterprise delivery capabilities
• Align demand, roadmaps, capacity, and governance to deliver scalable solutions across Government and Commercial claims
• Advance execution through disciplined intake, automation, configuration-first delivery, and product lifecycle management
• Establish intake, prioritization, and portfolio governance focused on high-value work
• Improve delivery speed, first-pass quality, and throughput by reducing rework and handoffs
• Strengthen product health, delivery readiness, risk visibility, and executive decision-making
• Partner with business, Operations, IT, Compliance, Audit, WFM, and other stakeholders
• Lead strategic workstreams and transformational priorities involving numerous special projects
• Plan, direct, and control resources and efforts across Digital Operations units
• Manage digitization initiatives, enterprise applications, delivery forecasts, and delivery plans
• Obtain people, funding, materials, and support for assigned units
• Ensure compliance with state and federal regulations
• Oversee strategic planning, budget development, cost centers, contract compliance, and regulatory integration
• Implement, monitor, and update disaster recovery and business continuity plans
• Provide 24x7x365 operational guidance and system solutions
• Execute annual projects with profit and loss responsibility
• Hire, train, coach, counsel, and evaluate direct reports
• Develop teams through training and organizational development practices
• Manage information system and programming activities of technical staff
• Monitor procedures and operational metrics using reporting and analytics tools
• Manage geographically diverse associates and vendor partners across multiple sites, states, and systems
• Manage unit budgets and build partnerships with market, digital, benefits, provider engagement, sales, and internal audit leaders
• Translate technical and business issues for non-technical and executive audiences
• Consult, facilitate, negotiate, persuade, and resolve intra-organizational issues
• Interface regularly with external customers and agencies

Director II – Digital Operations

Risk

• Support the Risk, Controls, and Assurance team in ensuring the stability and compliance of internal controls over financial reporting and audit/regulatory compliance obligations
• Create and document results of control testing and review
• Provide research support
• Develop work programs and engagement plans
• Collaborate with audit team members
• Assess risk of financial processes, operational processes, and supporting IT systems
• Document business processes dependent on financial data systems
• Analyze results of specific or general work requests
• Maintain direct contact with external audit firms for audit planning and remediation
• Perform innovative work supporting members, customers, and communities

Risk, Controls, and Assurance Intern

Customer Support

• Provide advanced service and sales support to brokers selling Medicare products
• Support Regional Sales Managers and Regional Sales Manager II as needed
• Engage lower-level producing brokers by telephone, written communications, face-to-face meetings, and webinars
• Assist with promoting and tracking co-op advertising and HRA campaigns
• Provide sales support for reporting, disenrollments, RFIs, special projects, broker onboarding and training, welcome kits, outbound call campaigns, and other assigned items
• Recruit non-Medicare-selling brokers to sell Medicare products
• Coordinate training logistics and face-to-face meetings/webinar participation for assigned brokers and regional sales managers

Regional Sales Support Representative

People Operations

• Serve as a strategic HR advisor supporting the Operations organization within Health Benefits
• Partner with business leaders to develop and execute insight-driven human capital strategies
• Translate business priorities into measurable workforce plans aligned with enterprise strategy and operational goals
• Provide consultation on organizational design, talent strategy, workforce planning, leadership development, and change management
• Support Health Benefits Operations leaders by translating business objectives into actionable people strategies and execution plans
• Leverage HR data, workforce analytics, and business insights to inform decisions and develop recommendations for executive and operational leaders
• Partner with HR Enablement Partners and Centers of Excellence to address workforce challenges and implement enterprise solutions
• Coach leaders through organizational change to drive adoption, engagement, and sustainable business outcomes
• Develop workforce and talent strategies supporting operational excellence, large-scale implementations, and organizational capability
• Operate within enterprise governance frameworks and identify and escalate complex, novel, or high-risk issues

People Strategy Partner

Enrollment Specialist

• Review and prioritize patient census
• Reach out to patients to explain services and enroll them in appropriate programs
• Provide support by addressing inquiries
• Schedule initial and annual appointments
• Enter documentation into designated systems
• Handle calls, texts, facsimiles, and electronic queues while taking notes and speaking to customers
• Resolve caller issues completely with empathy and persistence
• Work from the office as necessary based on business needs
• Participate in required in-person training sessions
• Work within a structured schedule, including occasional overtime or flexibility

Patient Enrollment Specialist I

• Review and prioritize patient census
• Reach out to new and existing patients
• Explain services to patients
• Enroll patients into appropriate programs based on line of business
• Address patient inquiries
• Schedule initial and annual appointments
• Enter documentation into designated systems
• Handle calls, texts, facsimiles, and electronic queues while taking notes and speaking with customers
• Work from the office as necessary
• Collaborate with patients through virtual and in-person interactions

• Serve as a strategic HR advisor to the Government Health Benefits organization
• Provide strategic consultation in organizational design, talent strategy, workforce planning, leadership development, and change management
• Translate business objectives into actionable people strategies and execution plans
• Leverage HR data, workforce analytics, and business insights to inform decisions and develop recommendations
• Partner with HR Enablement Partners and Centers of Excellence to address workforce challenges
• Coach leaders through organizational change to drive adoption, engagement, and sustainable outcomes
• Develop workforce and talent strategies supporting operational excellence and large-scale implementations
• Operate within enterprise governance frameworks and escalate complex, novel, or high-risk issues
• Align people strategies with health plan priorities in a regulated environment

• Serve as a strategic HR advisor supporting the Health Benefits organization
• Partner with business leaders to develop and execute insight-driven human capital strategies
• Provide strategic consultation in organizational design, talent strategy, workforce planning, leadership development, and change management
• Translate business objectives into actionable people strategies and execution plans
• Leverage HR data, workforce analytics, and business insights to inform decisions and develop recommendations
• Partner with HR Enablement Partners and Centers of Excellence to address workforce challenges and implement enterprise solutions
• Coach leaders through organizational change and drive adoption, engagement, and sustainable business outcomes
• Develop workforce and talent strategies supporting operational excellence, large-scale implementations, and organizational capability
• Operate within enterprise governance frameworks and identify or escalate complex, novel, or high-risk issues

Account Coordinator

• Provide advanced customer service representation for accounts
• Interpret and support plan benefit design
• Resolve complex claims, benefit, and enrollment issues
• Make routine account visits
• Coordinate open enrollment meetings
• Coordinate the renewal process and training sessions
• Coordinate on-site facility visits

Account Service Coordinator

Clinician

• Review clinical information and assess medical necessity under relevant guidelines and/or medical policies
• Ensure appropriate and consistent administration of plan benefits
• Handle complex cases requiring evaluation of multiple variables against guidelines
• Serve as a resource to lower-level clinicians and staff
• Collaborate with leadership on process improvement initiatives for utilization reviews and medical management
• Assess and apply medical policies and clinical guidelines within scope of licensure
• Conduct and potentially approve pre-certification, concurrent, retrospective, out-of-network, and appropriateness-of-treatment-setting reviews
• Process medical necessity denial determinations made by a Medical Director
• Develop and foster relationships with physicians, healthcare providers, and internal and external customers
• Refer complex or unclear reviews to higher-level nurses and/or Medical Directors
• Collaborate with leadership to enhance training and orientation materials
• Assist with process improvement initiatives
• Help train lower-level clinician staff
• Does not issue medical necessity non-certifications

Senior Medical Management Clinician

• Perform care management within the scope of licensure for members with complex and chronic care needs
• Assess, develop, implement, coordinate, monitor, and evaluate care plans across the care continuum
• Perform duties telephonically or on-site, such as at hospitals for discharge planning
• Ensure member access to services appropriate to their health needs
• Conduct assessments to identify individual needs and care management plans
• Facilitate authorizations and referrals within the benefits structure or through extra-contractual arrangements
• Coordinate internal and external resources to meet identified needs
• Monitor and evaluate care plan effectiveness and modify plans as necessary
• Interface with Medical Directors and Physician Advisors on care management treatment plans
• Negotiate reimbursement rates, as applicable
• Assist with provider, claims, or service issue problem solving

Security Engineer

• Develop, recommend, and implement enterprise information security policies, technical standards, guidelines, procedures, and infrastructure elements
• Select and deliver strategic network security, access control, and secure transaction/messaging solutions
• Own the management and evolution of the Information Security Strategy and Strategic Plan
• Lead annual planning, strategic refreshes, quarterly reviews, and certification of strategic priorities and success measures
• Drive quarterly strategy reviews and certifications with accountable leaders
• Develop executive- and Board-level narratives communicating strategy, progress, outcomes, risks, choices, and required decisions
• Identify emerging trends, risks, opportunities, and enterprise changes affecting Information Security strategy
• Strengthen strategy governance and execution discipline across Information Security
• Lead cross-functional orchestration of strategic priorities across Information Security
• Partner with initiative owners, portfolio leaders, Finance, Technology, Risk, and business stakeholders to resolve dependencies and execution barriers
• Connect strategic priorities to investment decisions, resource allocation, and portfolio planning
• Build partnerships across Technology, Enterprise Risk, Finance, business units, and other stakeholders
• Maintain an enterprise view of strategic risks, dependencies, decisions, and execution barriers
• Escalate issues and drive resolution across accountable leaders and teams

Pricing Manager

Nurse Case Manager I

Program Manager, Ohio Claims

Director II – Digital Operations

Risk, Controls, and Assurance Intern

Regional Sales Support Representative

People Strategy Partner

Patient Enrollment Specialist I

Patient Enrollment Specialist I

People Strategy Partner

People Strategy Partner

Account Service Coordinator

Senior Medical Management Clinician

Nurse Case Manager I

Information Security Strategy and Enablement