Provider Outreach Analyst II

Elevance Health

. Conduct outbound provider calls to confirm services were rendered and providers were expecting payment.

Posted 10/12/2026full-timeIndianapolis • Kentucky • United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in healthcare claims analysis and payment integrity, utilizing tools such as Facets and Macess to ensure compliance and accuracy in documentation. Strong analytical skills are essential for evaluating claims and recommending process improvements.

Highest-signal resume keywords

Healthcare Claims AnalysisPayment IntegrityFacetsMacessCPT, HCPCS, ICD-10 Codes

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims Processing WorkflowsData AnalysisSQLTableauMicrosoft Office

Soft Skills

Analytical SkillsCritical ThinkingCustomer ServiceOwnershipCollaboration

Tools & Technologies

FacetsMacessMicrosoft ExcelMicrosoft WordMicrosoft Outlook

Industry Keywords

Payment Integrity RecoveryHealthcareManaged CareRegulatory ComplianceSLA Requirements

Tech Stack

Tools & technologies

SQLTableau

About the role

Key responsibilities & impact

Conduct outbound provider calls to confirm services were rendered and providers were expecting payment.
Review claim details to determine claim validity before initiating outreach.
Meet or exceed daily outbound call attempt requirements.
Maintain a QA score of 95% or higher.
Meet SLA requirements related to outreach, documentation, and productivity.
Provide excellent customer service to providers.
Follow Desk Level Procedures, workflows, and operational guidelines.
Document call outcomes and follow-up activities in required systems.
Review and evaluate payment integrity recovery requests from external partners.
Analyze claim data using CPT, HCPCS, and ICD-10 codes.
Use Facets and Macess to research claims, validate overpayments, and document findings.
Collaborate with internal teams and external partners to clarify claim details.
Prepare and maintain documentation supporting recovery decisions.
Recommend process improvements and assist with corrective actions.
Ensure compliance with internal policies, regulatory requirements, and partner agreements.

Requirements

What you’ll need

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.
2–4 years of experience in healthcare claims analysis, payment integrity, or a related field preferred.
Proficiency with Facets, Macess, and Microsoft Office (Excel, Word, Outlook) preferred.
Experience with medical claims processing workflows and related systems preferred.
Experience supporting payment integrity or claims recovery in a health insurance or managed care environment preferred.
Prior experience identifying or developing new recovery opportunities/leads preferred.
Familiarity with data analysis and/or query tools (e.g., SQL, Tableau, or similar) preferred.
Ability to take ownership of assigned tasks, meet productivity goals, maintain high-quality standards, ensure timely and accurate documentation, and adhere to established procedures and SLAs preferred.
Strong analytical and critical-thinking skills for investigating complex healthcare claims, identifying discrepancies, evaluating payment integrity recovery opportunities, determining resolutions, and recommending process improvements preferred.
Candidates must reside within a reasonable commuting distance of a posting location unless an accommodation is granted as required by law.
Ability to work 8:00 am–5:00 pm ET, Monday to Friday, with additional hours as needed.
COVID-19 and Influenza vaccination may be required for certain patient/member-facing roles unless an acceptable explanation is provided.

Benefits

Comp & perks

Merit increases
Paid holidays
Paid Time Off
Incentive bonus programs
Medical benefits
Dental benefits
Vision benefits
Short-term disability benefits
Long-term disability benefits
401(k) + match
Stock purchase plan
Life insurance
Wellness programs
Financial education resources
Hybrid work arrangement with virtual-work flexibility