Vacancy expired!
Provider Pay Reconsider Analyst I/II- Nationwide- PS27237Location: United StatesNewRequisition #: PS27237Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care .This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.Provider Pay Reconsider Analyst I/IILEVEL 1This position supports the Payment Dispute process across all lines of business and is specifically responsible for the resolution of Provider Payment Reconsideration requests. Primary duties include, but are not limited to:
Reviews and analyzes provider requests to investigate the outcome of claim payment or denial.
Determines the appropriate resolution using strict adherence to internal guidelines, policies, and procedures.
Must work with various departments, when necessary, to determine root cause and appropriate resolution.
Must remediate impacted claims.
LEVEL 2This position supports the Payment Dispute process across all lines of business and is specifically responsible for the resolution of Provider Payment Reconsideration requests. Primary duties include, but are not limited to:
Reviews and analyzes provider requests to investigate the outcome of claim payment or denial.
Determines the appropriate resolution using strict adherence to internal guidelines, policies, and procedures.
Must work with various departments, when necessary, to determine root cause and appropriate resolution.
Must remediate impacted claims.
Responsible to manage Reconsideration escalations and may serve as a liaison between grievances & appeals and /or medical management, legal, service operations and/or other internal departments as appropriate.
AnEqualOpportunityEmployer/Disability/VeteranLEVEL 1
Requires a High school diploma or GED
3 years experience working in claims or customer service, familiarity with medical coding and medical terminology, demonstrated business writing proficiency, understanding of claims process, the company's internal business processes, and internal local technology
Or any combination of education and/or experience which would provide an equivalent background.
LEVEL 2
Requires a High school diploma or GED
1 year of Provider Payment Reconsideration Analyst I experience
3 years experience working in claims or customer service, familiarity with root cause remediation, medical coding and medical terminology, demonstrated business writing proficiency, understanding of claims process, the company's internal business processes, and internal local technology
Or any combination of education and/or experience which would provide an equivalent background.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. An Equal Opportunity Employer/Disability/Veteran
