Elevance Health

General

• Handle overpayments or reimbursement from other parties who may be liable for payment of claims
• Determine and calculate overpayment amounts
• Issue refund request letters, notice letters, or medication lists
• Process voluntary refunds
• Adjust claims based on refunds received
• Handle routine recovery issues

Recovery Specialist I

Client Partner

• Coordinate pharmacy compliance activities and initiatives across the PBM and enterprise
• Maintain the department-approved audit plan
• Implement effective internal controls
• Identify, monitor, revise, and track business-unit processes and implementing procedures
• Identify potential risks associated with PBM activities and establish procedures to minimize risks
• Partner with business units to ensure compliance with audit requirements
• Serve as a compliance subject matter expert on mandated projects
• Achieve operational compliance with HIPAA, SOX, and Privacy and Security Office initiatives
• Conduct, direct, lead, and facilitate internal and external regulatory and client audits
• Respond to audit findings
• Perform high-level audit research
• Develop strategic plans and proactively anticipate business needs and requirements
• Develop and implement training and communication plans
• Manage and lead scheduled and ad-hoc compliance projects
• Provide and deliver compliance consultation services to the business unit

Pharmacy Benefit Manager – Compliance Manager, Client Audit

Consultant

• Perform quality reporting to DHS, including Critical Incident reporting.
• Serve as a member advocate and work directly with members to assist with navigating care, appeals and grievances, maintaining income eligibility, and other member rights-related needs.
• Ensure the Member Rights Specialist/quality function remains fully independent from other health plan functions.
• Work with members, income maintenance agencies, ADRCs, and other partners to gather information needed to maintain member eligibility.
• Execute Member Rights Specialist and quality reporting activities within contractually-defined timelines and requirements.
• Manage the development, approval, implementation and compliance of ongoing external client-facing programs.
• Develop program budget.
• Ensure the program meets its stated objectives.
• Provide subject matter expertise in response to day-to-day business issues.
• Research applicable subject matter practices and remain aware of industry trends.
• Manage relationships and partner with corporate and regional business areas.
• Coordinate training related to the external client-facing program.
• Develop program success measures and perform periodic assessments of program success.

Program Consultant, Quality/Member Rights Specialist

Machine Learning Engineer

• Design, develop, and deploy AI/ML and Generative AI solutions addressing business and operational challenges at enterprise scale
• Build and maintain infrastructure, pipelines, and services connecting structured and unstructured data sources for AI-driven applications
• Develop reusable AI capabilities including RAG pipelines, vector search, semantic retrieval, prompt orchestration, and agentic workflows
• Implement evaluation frameworks and automated testing strategies measuring model quality, accuracy, bias, safety, and performance
• Establish monitoring, observability, and governance processes to keep AI systems reliable and compliant in production
• Collaborate with engineering and product teams to integrate AI capabilities into enterprise platforms and applications
• Drive adoption of Responsible AI practices through evaluation standards, audit-ready documentation, and model governance controls
• Optimize AI systems for scalability, latency, reliability, and cost efficiency
• Support experimentation, benchmarking, and model comparison to improve decision-making and accelerate AI innovation
• Partner with cross-functional stakeholders to translate business requirements into production-ready AI capabilities and services
• Contribute to technical standards, architecture decisions, and enterprise AI engineering best practices
• Develop experimental and analytic plans for machine learning algorithms and data modeling processes, using strong baselines and determining cause-and-effect relationships
• Enable responsible and scalable adoption of AI across Elevance Health’s healthcare enterprise

AI Machine Learning Scientist

Engineer

• Lead the design, development, and deployment of large-scale, production-grade artificial intelligence systems and platforms
• Work with senior leadership to solve complex, company-wide technical challenges
• Architect and deliver scalable, resilient AI solutions using agentic systems, large language models, distributed systems, and event-driven architectures
• Define enterprise-wide technical direction, architecture patterns, integration standards, and reusable platform capabilities
• Lead AI-driven modernization of legacy systems through automated code transformation, service decomposition, and continuous optimization
• Design and implement AI-enabled software development lifecycle practices to improve engineering velocity and quality
• Establish technical standards, governance frameworks, and best practices for AI systems, including monitoring, evaluation, and responsible AI
• Partner with engineering teams and stakeholders to enable adoption of AI-assisted development
• Drive continuous improvement in system performance and productivity
• Provide technical leadership and mentorship
• Influence enterprise technology decisions through deep expertise and hands-on engineering

Distinguished Engineer

• Translate highly complex and varied business needs into application software requirements
• Provide expertise to lower-level consultants on analyzing business needs and determining optimal solutions
• Determine business application software requirements for highly complex and varied business needs
• Lead teams of analysts assigned to the most complex and high-impact projects
• Analyze and design solutions addressing varied and highly complex business needs
• Travel to worksites and other locations as necessary
• Work in a hybrid arrangement with in-office attendance 1–2 days per week

Senior Business Consultant

Medical Director

• Support medical management staff in ensuring timely and consistent medical decisions for members and providers
• Complete clinical case reviews for the relevant board-certified specialty
• Make physician-to-physician calls to gather medically appropriate information
• Make medical necessity determinations for grievance and appeals within the relevant specialty
• Ensure consistent use of medical policies in medical necessity decisions
• Escalate case review decisions requiring Medical Director review or policy interpretation to supervisors
• Attend required in-person training sessions

Associate Medical Director – Post Acute Care

Nurse Practitioner

• Provide patient care within scope of practice in the clinical setting
• Administer ordered therapies according to prescriber orders, facility protocols, INS standards, and company policies and procedures
• Complete the admission process as directed by the Center Director
• Perform physical assessments on patients and new consults as warranted by diagnosis
• Document pertinent data in patients’ medical records
• Report significant changes or observations to the Center Director and follow up on identified problems
• Communicate patient status and observations with IV team members
• Maintain patient confidentiality in accordance with HIPAA laws and regulations
• Evaluate patients’ responses to therapy and document findings
• Educate patients and/or family members regarding therapy plans
• Participate in the Quality Improvement program
• Ensure medication orders are complete, appropriate, accurate, and up to date before treatment
• Provide clinical coverage for nurse practitioners on PTO/LOA
• Support new market launches as needed
• Travel extensively to worksites and other locations as necessary

Family Nurse Practitioner – PRN

Analyst

• Analyze, report, and develop recommendations on complex and varied business metrics
• Provide technical assistance to lower-level staff
• Take ownership of supported systems and data
• Create and maintain databases to track business performance
• Analyze data and summarize performance using summary statistical procedures
• Develop and analyze business performance reports for claims, provider, utilization, and related data
• Document performance deviations and anomalies
• Create and publish periodic and ad hoc reports
• Devise diagnostic and tracking data solutions that translate business requirements into decision-support tools
• Make recommendations based on data analysis
• Question inefficient processes and recommend improved designs
• Automate repetitive work and introduce approaches that improve performance, reliability, and maintainability
• Collaborate while independently solving complex data challenges

Senior Business Information Analyst

Nurse

• Review complex or challenging cases requiring nursing judgment, critical thinking, and holistic assessment
• Determine whether requested services are medically necessary and approve services when appropriate
• Work with healthcare providers to understand and assess members’ clinical presentations
• Apply clinical guidelines and organizational policies to evaluate medical necessity
• Promote quality member outcomes, optimize member benefits, and support effective resource use
• Identify abnormalities and assess complex clinical concepts, symptoms, and aggregate member information
• Recognize inappropriate type, level, or quality of care
• Consult with Medical Directors on peculiar, complex, unclear, or clinically unmet cases
• Recommend alternate types, places, or levels of appropriate care
• Collaborate with case management nurses on discharge planning, including equipment, environment, and education needs
• Serve as a resource to lower-level nurses and provide nursing consultation to Medical Directors and providers
• Participate in intradepartmental teams, cross-functional teams, special projects, initiatives, and process improvement activities
• Educate members about plan benefits and physicians and assist with case management
• Collaborate with leadership to enhance training and orientation materials
• Complete quality audits and assist with corrective action plans
• Help train lower-level clinician staff

Medical Management Nurse

Pharmacist

• Maximize the client base and strengthen existing relationships within a set territory
• Achieve defined sales targets and demonstrate strong understanding of relevant disease states
• Achieve sales of new accounts while maintaining relationships with existing accounts
• Maintain sales effectiveness within the assigned territory
• Use databases and other tools to identify key accounts and maximize referral potential
• Develop and foster account relationships and maintain and document a call cycle
• Build and extend relationships with pharmaceutical counterparts and maintain internal partnership
• Support all specialty pharmacy activity
• Partner with the leadership team to formulate and execute business objectives
• Attend and participate in sales meetings, training programs, conventions, and similar events
• Communicate competitor information, territory issues, business threats, and relevant information to the leadership team

Regional Account Liaison – BioPlus Specialty Pharmacy

• Lead the design, development, and modernization of enterprise workflow experiences
• Partner with product, design, business units, platform teams, and enterprise architecture to simplify processes and improve user experience
• Architect and deliver scalable, resilient AI solutions using agentic systems, LLMs, distributed systems, and event-driven architectures
• Define enterprise-wide technical direction, architecture patterns, integration standards, and reusable platform capabilities
• Lead AI-driven modernization of legacy systems through automated code transformation, service decomposition, and continuous optimization
• Design and implement AI-enabled software development lifecycle practices
• Establish technical standards, governance frameworks, monitoring, evaluation, and responsible AI best practices
• Collaborate with UX, product management, engineering, operations, architecture, security, compliance, and business stakeholders
• Enable adoption of AI-assisted development and drive continuous improvement in system performance and productivity
• Modernize legacy workflow tools, forms, portals, manual processes, and fragmented user experiences
• Provide technical leadership and mentorship and influence enterprise technology decisions and AI investments

• Partner with National Account Sales and Account Management teams in support of National clients
• Provide thought leadership to positively impact healthcare quality, outcomes, and cost for Commercial and National customers
• Support the sales process and drive new sales growth
• Support expansion of clinical products and programs to large National Accounts and other business segments
• Cultivate relationships with decision-makers and influencers within prospective customers
• Develop strategic messaging and partner with Sales RVPs, Account Executives, and Account Managers for new sales
• Support account finalist opportunities and client quarterly and annual reviews
• Ensure high-quality and efficient medical services are provided to accounts
• Serve as the voice of health policy to clients and advise them on clinical programs and strategy
• Provide counsel as a medical subject matter expert on relevant strategies and initiatives
• Represent the company on external committees or with applicable vendors as needed
• Foster continuous improvement and best practice sharing in support of clinical models

Account Management Medical Director – RVP

• Coordinate follow-up care plan needs by scheduling appointments or enrolling members in programs
• Assess member compliance with medical treatment plans by telephone or through on-site visits
• Identify barriers to plan compliance and coordinate resolutions
• Identify opportunities affecting quality goals and recommend process improvements
• Recommend treatment plan modifications and determine the need for additional services with case management and providers
• Coordinate identification of and referrals to local, state, or federally funded programs
• Coach members on ways to reduce health risks
• Prepare reports documenting case and compliance updates
• Establish and maintain relationships with agencies identified in appropriate contracts
• Ensure appropriate member treatment plans are followed on less complex cases
• Proactively identify ways to improve member health and meet quality goals

Outreach Care Specialist

Sales Development Rep

• Identify, engage, and cultivate relationships with potential clients and current customers
• Deploy efficient lead-generation processes and metrics
• Create and nurture high-quality leads
• Contact prospects via email, phone, and social media to initiate contact and schedule discovery meetings
• Conduct market research to identify growth opportunities and target segments
• Analyze lead-generation efforts and communicate results
• Produce regular performance reports, insights, and recommendations for senior management
• Collaborate with cross-functional internal partners on business objectives, new solutions, product launches, and unique selling propositions
• Use lead-generation products, platforms, and core technology stack
• Establish and optimize end-to-end lead-generation processes for high conversion rates
• Ensure lead-generation activities comply with regulations and best practices
• Drive outbound activity, connections, response time, meetings set and held, pipeline generated/influenced, conversion rates, data hygiene, and process adherence

Recovery Specialist I

Pharmacy Benefit Manager – Compliance Manager, Client Audit

Program Consultant, Quality/Member Rights Specialist

AI Machine Learning Scientist

Distinguished Engineer

Senior Business Consultant

Associate Medical Director – Post Acute Care

Family Nurse Practitioner – PRN

Senior Business Information Analyst

Medical Management Nurse

Regional Account Liaison – BioPlus Specialty Pharmacy

Distinguished Engineer

Account Management Medical Director – RVP

Outreach Care Specialist

Lead Generation Specialist / Sales Development Representative