, Georgia

Description

SHIFT: Day Job

SCHEDULE: Full-time

Responsible for Provider Issues Resolution (PIR) escalations across all lines of business and is responsible for the resolution of provider payment escalation requests and communication of contracts along with Anthem's medical and clinical policies. Primary duties include but are not limited to: remediate impacted high dollar multi claim issues (request and analyze claim impact reports & initiate sweeps), investigate the outcome of claim payment or denial, adjusts complex claims for a specific line of business and market, adjust voids, rekey and reopen claims on-line within guidelines to ensure proper adjudication, interpret benefits, policies and procedures, provider contracts, and adjudication of claims, analyze systems and processes that span across multiple operational area and claim systems, recommend resolution for contract dispute, non-routine claim issues, billing questions and other practices, identify barriers and facilitates process improvement projects and coordinates communication processes on medical policy, reimbursement, and provider utilization patterns. May serve as a liaison and SME with internal and external business partners. Collaborates with internal and external business partners to determine root cause and solve for appropriate resolution. Requires a high school diploma or GED and a minimum of 6 years of claims research/customer service experience 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.

Qualifications

Requirements:

  • High school diploma or GED
  • Minimum of 6 years of claims research/customer service experience 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

Preferred Requirements: 

  • Medicare claims experience 

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.

Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

, Georgia

If you are active-duty military, reserve, or a military veteran, we foster a welcoming environment that’s dedicated to honoring your service and helping you achieve your career goals. Veterans of Anthem — one of our Business Resource Groups — partners with our Talent Acquisition teams to maximize career offerings for you and your family members, striving to help you transition to civilian service and grow your career at the same time. 

Join Anthem's Military and Veteran Talent Network: https://anthemcareers.ttcportals.com/pages/military 

WE ARE HIRING

Anthem, Inc. is currently seeking military veterans and military spouses for a variety of open roles.  Our immediate needs include Support Technical Engineer, Lead Engineer, Developer, Systems Analyst, Network Data Specialist, and Provider Network Manager roles.  Whether you are looking to transition into an IT career or if you have experience under your belt in the Technology field, Anthem wants to have an impact on your career and professional growth by speaking with you about their career opportunities.

If you are interested in learning more, check out Anthem's current open positions to the right for more information and to apply today!

Not sure where to start?  Send RecruitMilitary Success Manager, Taylor Groves, your questions at taylor.groves@recruitmilitary.com 

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