, New Jersey

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater 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.

Job Title: Provider Resolution Manager Sr

Locations: Any of the following states supporting our Northeast region: NY, NJ, ME, MA, PA, CT, DE, MD, VA

Status: Individual Contributor, Work at home, Full-time, Salary, Bonus Potential

The Provider Resolution Manager Sr is responsible for providing quality, accessible and comprehensive service to the company's provider community.

Primary duties may include, but are not limited to:

  • Develops and maintains positive provider relationships with provider community by regular and/or virtual/digital visits, communicating administrative and programmatic changes, and facilitating education and the resolution of provider issues.
  • Periodic on-site visits as needed.
  • Serves as a knowledge and resource expert regarding the most complex provider issues impacting provider satisfaction; researches and resolves the most complex provider issues and appeals for prompt resolution.
  • Works with internal matrix partners to triage issues and submit work requests.
  • Is assigned all Tiers of Hospitals/Facilities and/or National Ancillary provider groups.
  • Functions as a high level technical resource to resolve or facilitate complex provider issues.
  • In collaboration with Provider Experience, coordinates Joint Operation Committees (JOC) of hospital/facility and/or National Ancillary provider groups, driving the meetings in the discussion of issues and changes.
  • Provides assistance regarding Annual Provider Satisfaction Surveys and required corrective action plan implementation and monitoring education, contract questions and non-routine claim issues.
  • Coordinates communications process on such issues as administrative and medical policy, reimbursement and provider utilization patterns. Manages inventory impacting up to $500M A/R.
  • Conducts claim and trend analysis.
  • Coordinates prompt claims resolution through direct contact with providers, claims, pricing and medical management department.
  • Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery.
  • Researches issues that may impact future provider negotiations or jeopardize network retention.
  • May be responsible for monitoring department metrics, provider assignments and oversight of daily activities.
  • Travel may be required

Qualifications

  • Bachelor's degree
  • A minimum of 5 years of customer service experience
  • Any combination of education and experience, which would provide an equivalent background.

Preferences

  • Claims knowledge
  • Managed Care 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.

, New Jersey

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 

Similar jobs