Consulting, Payment Integrity, Transformation - Associate Director - Process Excellence - CO - GR - 30846-49624-2 - JR197865

Position Title:

Consulting, Payment Integrity, Transformation - Associate Director - Process Excellence - CO - GR - 30846-49624-2 - JR197865

Job Family:

BSP > Process Improvement

Shift:

Job Description:

Job Title

Associate Director - Process Excellence

Requirement Type

Full-Time Employee

Job Location

Bangalore / Hyderabad /Gurugram

Job Level

Associate Director

Hiring Manager

Director Process Automation

Primary Skill

Consulting, Payment Integrity, Transformation

Business

Transformation and growth Office - Corporate

Individual Contributor / People Manager

Individual Contributor

ABOUT ELEVANCE HEALTH

Elevance Health is a leading health company in America dedicated to improving lives and communities and making healthcare simpler.  It is the largest managed health care company in the Blue Cross Blue Shield (BCBS) Association serving more than 112 million individuals across 14 states.

A regular in Fortune 500 list, Elevance Health ranked 18 in 2026. Gail Boudreaux, President and CEO of Elevance Health has been a consistent name in the Fortune list of most powerful women and currently holds 81st rank on this list.

ABOUT CARELON GLOBAL SOLUTIONS

Carelon Global Solutions (CGS) is a healthcare solutions company simplifying complex operational processes to improve the health of the healthcare system.

Previously known as Legato Health Technologies, Carelon Global Solutions (hereinafter, CGS) underwent a name change and joined the Carelon family of brands in January 2023, as a fully owned subsidiary of Elevance Health (Previously Anthem Inc.). CGS brings together a global team of like-minded innovators who manage and optimize operational processes for health plans as well as providers.

Our brightest minds housed across our global headquarters in Indianapolis as well as Bengaluru, Hyderabad and Gurugram in India, Manila in the Philippines, and San Juan in Puerto Rico bring with them innovative capabilities and an unmatched depth of experience. This global team uniquely positions CGS to enable scalable, next-generation platforms and specialized digital tools that make healthcare operations more practical, effective, and efficient.

OUR MISSION & VALUES

Our Mission: Improving Lives and Communities. Simplifying Healthcare. Expecting More.
Our Values: Leadership | Community | Integrity | Agility | Diversity

JOB PURPOSE

• Carelon Global Solutions India is seeking an Associate Director - Process Excellence.
• In this role, you will be primarily responsible for driving Payment Integrity initiatives across Carelon’s Corporate and Healthcare domains, ensuring payment accuracy, cost optimization, and operational excellence.

JOB RESPONSIBILITY

• Lead payment integrity programs for healthcare payer clients to identify and recover claim overpayments.
• Analyze medical and pharmacy claims to detect billing errors, fraud, waste, abuse, and contract compliance issues.
• Design and implement pre-payment and post-payment claim editing strategies.
• Collaborate with clinical, operations, analytics, and technology teams to improve payment accuracy.
• Manage client relationships, present insights, and recommend cost-saving opportunities.
• Drive automation and AI-enabled payment integrity solutions.
• Monitor KPIs such as savings, accuracy, audit yield, and provider abrasion.
• Support product development for payment integrity solutions, including business requirements, prioritization, and go-to-market initiatives.
• Lead cross-functional teams and mentor analysts and consultants.

QUALIFICATION

• Bachelor's degree (Master's/MBA preferred).

EXPERIENCE

• 6 - 15+ years of experience in healthcare consulting, payment integrity, claims operations or payer analytics.
• Experience working with U.S. health plans or healthcare services organizations is preferred.

SKILLS AND COMPETENCIES

• Strong knowledge of the U.S. healthcare payer ecosystem, claims processing, and reimbursement methodologies.
• Experience in payment integrity, claims analytics, utilization management, or healthcare operations.
• Understanding of coding systems (ICD-10, CPT, HCPCS, DRG), provider contracts, and reimbursement policies.
• Analytical skills with SQL, Excel, and visualization tools (Power BI/Tableau); familiarity with AI/ML is a plus.
• Strong stakeholder management, consulting, and presentation skills.
• Experience leading strategic initiatives and cross-functional teams.

THE CARELON PROMISE

Aligning with our brand of belief of ‘limitless minds are our biggest asset’, we offer a world of limitless opportunities to our associates.

It is our strong belief that one is committed to a role when it is not just what the role entails, but also what lies in its periphery that completes the value circle for an associate.

This world of limitless opportunities thrives in an environment that fosters growth and well-being, and gives you purpose and the feeling of belonging.

LIFE @ CARELON

• Extensive focus on learning and development
• An inspiring culture built on innovation, creativity, and freedom.
• Holistic well-being
• Our culture and initiatives are underpinned by diversity, equity and inclusion
• Varied opportunities for rewards and recognitions
• Competitive health and medical insurance coverage
• Best-in-class amenities and workspaces
• Policies are designed with associates at the center.

EQUAL OPPORTUNITY EMPLOYER

Carelon Global Solutions is committed to a diverse and inclusive workplace and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, disability, age, veteran status, or other characteristics.

Reasonable Accommodation

Our inclusive culture empowers Carelon to deliver the best results for our customers. We not only celebrate the diversity of our workforce, but we also celebrate the diverse ways we work.

If you have a disability and need accommodation such as an interpreter or a different interview format, please ask for the Reasonable Accommodation Request Form.

Disclaimer: Offered designation titles differ*

Job Type:

Full time