Elevance Healthposted over 7 years ago
Full-time
Remote • Winchester, VA
Insurance Carriers and Related Activities
Title: Claims Resolution Analyst - Remote Worker - 135057
COMPANY: Anthem
Location ZipCode: 22604
Job Description: /Your Talent. Our Vision./At Anthem, Inc.,itâs a powerful combination, and the foundation upon which weâre creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we willdrive 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.
Claims Resolution Analyst â Remote Worker - 135057
TheClaims Resolution Analystis responsible for coordinating the resolution of claims issues by actively researching and analyzing systems and processes that span across multiple operational areas. Primary duties may include, but are not limited to:
- Investigates and facilitates the resolution of claims issues, including incorrectly paid claims, by working with multiple operational areas and health plans and analyzing the systems and processes involved in member enrollment, provider information management, benefits configuration and/or claims processing.
- Identifies the interdependencies of the resolution of claims errors on other activities within operations.
- Assists in the reviews of state or federal complaints related to claims.
- Coordinates the efforts of several internal departments to determine appropriate resolution of issues within strict timelines.
- Interacts with network providers and health plans regularly to manage customer expectations, communicate risks and status updates, and ensure issues are fully resolved.
- Performs claims and trend analysis, ensures supporting documentation is accurate and obtains necessary approvals to close out claims issues.
Requires:
- High School Diploma or equivalent.
- Minimum of 3 years of claims research and/or issue resolution or analysis of reimbursement methodologies within the health care industry
- Or any combination of education and experience, which would provide an equivalent background.
- Previous health plan and/or provider experience strongly preferred.
- Bachelor's Degree (BA/BS) preferred.
/Anthem, Inc. is ranked as one of Americaâs Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.__/
Job Claims
Equal Employment Opportunity Statement
Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.
Title: Claims Resolution Analyst - Remote Worker - 135057
Location: virginia-Winchester
Requisition ID: 135057
Education level:
experience:
license:
training:
work Shift:
Shift Duration:
hours per week:
salary: -
NAICS:
company information:
company mail:
company direct:
company online:
company phone:
company fax:
company email:
fein: 35-2145715
fedcontractor: 1
COMPANY: Anthem
Location ZipCode: 22604
Job Description: /Your Talent. Our Vision./At Anthem, Inc.,itâs a powerful combination, and the foundation upon which weâre creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we willdrive 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.
Claims Resolution Analyst â Remote Worker - 135057
TheClaims Resolution Analystis responsible for coordinating the resolution of claims issues by actively researching and analyzing systems and processes that span across multiple operational areas. Primary duties may include, but are not limited to:
- Investigates and facilitates the resolution of claims issues, including incorrectly paid claims, by working with multiple operational areas and health plans and analyzing the systems and processes involved in member enrollment, provider information management, benefits configuration and/or claims processing.
- Identifies the interdependencies of the resolution of claims errors on other activities within operations.
- Assists in the reviews of state or federal complaints related to claims.
- Coordinates the efforts of several internal departments to determine appropriate resolution of issues within strict timelines.
- Interacts with network providers and health plans regularly to manage customer expectations, communicate risks and status updates, and ensure issues are fully resolved.
- Performs claims and trend analysis, ensures supporting documentation is accurate and obtains necessary approvals to close out claims issues.
Requires:
- High School Diploma or equivalent.
- Minimum of 3 years of claims research and/or issue resolution or analysis of reimbursement methodologies within the health care industry
- Or any combination of education and experience, which would provide an equivalent background.
- Previous health plan and/or provider experience strongly preferred.
- Bachelor's Degree (BA/BS) preferred.
/Anthem, Inc. is ranked as one of Americaâs Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.__/
Job Claims
Equal Employment Opportunity Statement
Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.
Title: Claims Resolution Analyst - Remote Worker - 135057
Location: virginia-Winchester
Requisition ID: 135057
Education level:
experience:
license:
training:
work Shift:
Shift Duration:
hours per week:
salary: -
NAICS:
company information:
company mail:
company direct:
company online:
company phone:
company fax:
company email:
fein: 35-2145715
fedcontractor: 1
