Payment Integrity Program Manager Jobs in Wisconsin

Cost of Care Manager

Location: This role requires associates to be in-office 1-2days 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.

The Cost of Care Manager leads and manages multiple cost of care initiatives enterprise wide (e.g. local, within each state, across business segments and at the enterprise level) and drives their execution. Understands, predicts and implements measures to control healthcare costs and to make healthcare more affordable for our customers. Develops, manages, oversees, and executes new and innovative initiatives to manage rising costs and enhance the company's market competitiveness.

How you will make an impact:

• Partners with cross-functional teams to support cost of care initiatives across markets, states, business segments, and enterprise functions.
• Reviews post-implementation claims, utilization, provider reimbursement, payment policy, operational, and financial data to evaluate cost of care project performance.
• Works with Cost of Care Analytics, Finance, Actuarial, Claims, Provider Network, Care Management, IT, and business partners to analyze project outcomes, assess financial impact, and support performance discussions.
• Supports the development of financial models, savings validation, risk assessments, business cases, and performance tracking for cost of care initiatives.
• Reviews claims data after implementation to analyze trends related to unit cost, utilization, provider billing patterns, reimbursement changes, benefit configuration, claims operations, and potential payment leakage.
• Collaborates with actuarial and finance partners to compare projected savings against actual results and support accurate performance measurement and reporting.
• Helps develop and maintain dashboards, reports, executive summaries, and project tracking materials to communicate post-implementation performance and financial outcomes.
• Supports claims-related affordability initiatives, including payment integrity, claims editing, reimbursement policy review, vendor performance, benefit configuration, and operational process improvement.
• Provides data-driven recommendations and insights to business partners and leadership based on project performance, claims results, and financial outcomes.
• Participates in cost of care planning meetings, workgroups, and performance discussions to help monitor progress, risks, dependencies, actual savings, and financial impact.
• Serves as a claims and financial analysis resource for assigned cost of care initiatives and cross-functional business partners.

Minimum Qualifications:

• Requires a BS/BA degree and minimum of 5 years relevant experience in Health Care; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Strongly preferred Financial, Business, and Leadership acumen.
• MBA, MHA, MA; PMP or Six Sigma Green Belt.
• Prior experience with provider network contracting, provider networks, claims, finance, and operations.

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 should submit the Accessibility Accommodation Request Form and a member of the team will be in contact.

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.