Utilization Management Assistant Jobs in Virginia

Trend & Analytics Consultant Senior (Actuarial Business Consultant)

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

The Trend & Analytics Consultant Senior (Actuarial Business Consultant) is a senior-level analytics role responsible for identifying, investigating, and explaining major trend drivers within an assigned business area. This role uses advanced analytical thinking, healthcare business knowledge, and data-driven insights to uncover root causes, identify emerging issues, and inform internal and external customers of meaningful trends, risks, and opportunities. The position operates with a high degree of independence and is expected to proactively identify areas of concern, develop actionable recommendations, and influence business decisions. The Healthcare Trend & Analytics Consultant Sr. also serves as a leader in the adoption of new tools, technologies, and analytical approaches, including artificial intelligence, automation, and advanced data visualization. This role acts as a mentor, subject matter expert, and resource for more junior analysts and cross-functional business partners.

PLEASE NOTE: This position is not eligible for current or future visa sponsorship.

How You Will Make an Impact:

• Identifies, monitors, and analyzes major healthcare trends within an assigned business area, including cost, utilization, clinical, operational, financial, and/or customer-impacting trends.
• Proactively investigates emerging issues, anomalies, and performance changes to determine root causes and quantify business impact.
• Develops clear, actionable insights and recommendations that help customers and business partners understand trends and determine potential next steps.
• Translates complex data and analytics into concise, meaningful narratives for senior leaders, business partners, and non-technical audiences.
• Leads complex analytical projects with limited direction, including defining the problem, determining the appropriate methodology, gathering and validating data, conducting analysis, and presenting findings.
• Serves as a senior analytical consultant to assigned business areas by helping frame business questions, identify key drivers, and evaluate potential solutions.
• Develops and enhances reporting, dashboards, analytical models, and monitoring tools to improve visibility into key trends and performance indicators.
• Leads adoption of new tools, technologies, and analytical capabilities, including AI-enabled tools, automation, self-service analytics, and advanced visualization platforms.
• Promotes responsible and effective use of AI and emerging technologies to improve analytical quality, efficiency, and insight generation.
• Identifies opportunities to improve analytical processes, standardize methodologies, reduce manual work, and increase consistency across reporting and analysis.
• Anticipates customer needs and proactively surfaces insights, risks, and opportunities before they are formally requested.
• Performs key actuarial functions including new product pricing, evaluation of the impact of new legislation, flexible benefit consulting, and special projects.
• Designs and completes special projects such as developing and maintaining experience-rating formulae and creating and/or reviewing alternative settlement formulate and risk sharing models.
• Responsible for recommendations on pricing, marketing, product design, claims, premium and enrollment administration of business unit.
• Responsible for valuation support for business unit by interpreting financial results, variances from forecast to help identify product and segment behavior to assist in the risk management of the business unit.

Minimum Requirement:

Requires a BA/BS in Mathematics, Statistics or related field and minimum of 8 years related experience in an actuarial environment performing financial reporting, rate development, evaluation of risk contingencies and/or trend projections; or any combination of education and experience, which would provide an equivalent background.

• Healthcare analytics experience.

• Experience with utilization management data strongly preferred.

• Experience with Utilization Management systems and Behavioral Health programs highly desired.

• 4 years of database development and data management.

• Experience with Snowflake.

• Strong experience in MS SQL Server (2016 or newer).

• Proficiency in reporting and visualization tools (Tableau, Power BI, SSRS).

• Advanced SQL skills, including writing complex queries and stored procedures

• Strong Excel and general data analysis skills.

• Excellent communication skills, project management/implementation, interpersonal and organizational skills.

• Demonstrated curiosity, initiative, and a strong desire to learn.

For candidates working in person or virtually in the below locations, the salary* range for this specific position is $103,360 to $179,520.

Location(s): Virginia, Illinois, Maryland

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a 'sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions Associates in these jobs must follow the specific policies, procedures, guidelines, etc as stated by the Government Business Division in which they are employed.

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.