Strategic Planning Director - Payment Integrity

Location: This role requires associates to be in-office 3 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 an accommodation is granted as required by law.

Carelon , a proud member of the Elevance Health family of companies, is a healthcare services organization that takes a whole-health approach to making care more integrated, personalized, and affordable. We put people at the center-connecting physical, behavioral, social, and pharmacy services, along with clinical expertise, research, operations, and advanced technology to help care work better, together.

Among us are care providers, engineers, data scientists, and other dedicated professionals determined to recover, eliminate and prevent unnecessary medical-expense spending.

The Strategic Planning Director - Payment Integrity is responsible for managing the enterprise wide planning process for a VP and above, with a primary focus on advancing payment integrity strategy, strengthening end-to-end processes, and driving measurable improvements in cost avoidance, recovery, and prevention.

How You Will Make An Impact

• Directs the monthly/quarterly reporting process and annual operating plan development, ensuring alignment with payment integrity performance goals and value realization targets.
• Ensures strategic rationale and initiatives are in sync with corporate direction and enterprise payment integrity objectives.
• Develops the annual business plan and quarterly forecast materials and tools, incorporating process improvement priorities and operational efficiency metrics.
• Coaches business planning participants on requirements, analysis, and deadlines, with emphasis on disciplined execution, root cause analysis, and continuous process improvement.
• Manages strategic payment integrity projects, reports, and analyses, identifying opportunities to enhance accuracy, efficiency, and scalability.
• Leads the development and direction of selected issues and projects, driving cross-functional process optimization and sustainable performance improvement.
  
  

Minimum Requirements

• Requires a BA/BS degree in a related field and a minimum of 10 years of related experience; or any combination of education and experience, which would provide an equivalent background.
  
  

Preferred Skills, Capabilities And Experiences

• 3-5 years of experience in Payment Integrity is strongly preferred.
• Experience in payment integrity: claim editing, recoveries, cost of care, or financial project management is highly desired.
• Experience in successfully developing and managing projects with significant operating budgets and knowledge of process redesign is strongly preferred.
• Project management experience desired.
• Experience with claims processing systems, such as GBD Facets and/or WGS highly desired.
• Experience facilitating and presenting to large audiences preferred.
• Experience in successfully developing and managing projects with a fairly significant operating budget.
• Knowledge of process redesign is strongly preferred.
  
  

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

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 may contact [email protected] for assistance.

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/) .