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Elevance Health Logo Elevance Health · IT - Administration

Audit & Reimbursement Lead - Appeals

United States, IN-INDIANAPOLIS Employment contract 87120.00 - 137214.00 USD / Year · Job Posted July 03, 2026

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Job Description

The Audit & Reimbursement Lead - Appeals is responsible for providing technical direction, workload planning, associate mentoring and operational support on a day-to-day basis.

Job Responsibility

  • Reviews work of the associates to ensure they are following the appropriate guidelines, provides training both in a formal and informal setting, reviews the policies and procedures to make sure they are appropriate, and monitors workload inventory to ensure timely completion
  • Handles complex case research and resolutions
  • Will support the Appeal Unit with appeal issues as assigned
  • Participates in special projects and review of work done by lower level auditors
  • Analyzes and interprets data and makes recommendations for change based on their judgment and experience
  • Able to work independently on assignments and under minimal guidance from the manager
  • Monitors inventory to ensure workflow remains uninterrupted
  • Assists management with workload and financial budget responsibilities
  • Must have extensive knowledge of CMS principles, law and regulations
  • Works with management on interaction with internal and external audits and performance measures
  • Assists in ISO and NASBA certification activities
  • Associates in this role are expected to maintain continuing education requirements

Requirements

  • Requires a BA/BS degree and a minimum of 8 years audit/reimbursement or related Medicare experience which includes previous experience at a Senior Auditor level in health care, public accounting or a government agency
  • or any combination of education and experience, which would provide an equivalent background
  • This position is part of our Wellpoint Federal division which, per CMS TDL 190275, requires foreign national applicants to meet the residency requirement of living in the United States for at least three of the past five years.

Nice to have

  • Accounting degree preferred
  • Experience in software used to file and finalize cost reports and experience with paperless audit software applications preferred
  • Demonstrated leadership experience
  • through knowledge of CMS program regulations and cost report format preferred
  • Knowledge of CMS computer systems and Microsoft Office Word and Excel strongly preferred
  • MBA, CPA, CIA or CFE preferred

What we offer

  • comprehensive benefits package
  • incentive and recognition programs
  • equity stock purchase and 401k contribution
  • merit increases
  • paid holidays
  • Paid Time Off
  • incentive bonus programs
  • medical
  • dental
  • vision
  • short and long term disability benefits
  • 401(k) +match
  • stock purchase plan
  • life insurance
  • wellness programs
  • financial education resources
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