Anthem Claims Resolution Analyst or Sr. Job Family 128749 in Louisville, Kentucky

/ Your Talent. Our Vision. / At Amerigroup , a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination. It’s 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.

Claims Resolution Analyst or Sr. Job Family

  • Level will be determined by skills and experience of selected candidate*

Claims Resolution Analyst

The incumbent is responsible coordinating the resolution of claims issues by actively researching and analyzing systems and processes that span across multiple operational areas.

PRIMARY RESPONSIBILITIES:

  1. 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.

  2. Identifies the interdependencies of the resolution of claims errors on other activities within operations.

  3. 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.

  4. Interacts with network providers and health plans regularly to manage customer expectations, communicate risks and status updates, and ensure issues are fully resolved.

  5. Performs claims and trend analysis, ensures supporting documentation is accurate and obtains necessary approvals to close out claims issues.

  6. Recommends new or modified processes and procedures to reduce claims errors, taking into consideration business requirements and system limitations

  7. Performs user acceptance testing to ensure new contracts are loaded correctly and system modifications are accurate

  8. Performs other duties as assigned.

Claims Resolutions Analyst Sr.

The incumbent is responsible for researching, analyzing, documenting and coordinating the resolution of escalated and/or complex claims issues that span across multiple operational areas and requires expert knowledge of all systems, tools and processes. When appropriate, the incumbent will provide project team leadership and will coordinate the identification and resolution of root causes involving configuration, claims and/or contracting activities.

Claims Resolution Analyst

Bachelors degree, or equivalent related experience. Three years of claims research and/or issue resolution or analysis of reimbursement methodologies within the health care industry.

Claims Resolution Analyst Sr.

Requires Bachelors degree, or equivalent related experience and five 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.

Requirements for both levels:

  • Previous experience adjusting and processing claims,

  • Previousexpeirence reviewing claims and making reimbursement determinations.

  • Previous experience resolving provider claims and reimburse disputes.

  • Previous experience resolving claim pricing issues.

  • Healthcare/Payer Experience

Prior Anthem IRU experience is highly preferred.

/ Anthem, Inc. is ranked as one of America’s 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 please visit us atwww.antheminc.com/careers. EOE. M/F/D/V. /

Job Claims

Title: Claims Resolution Analyst or Sr. Job Family 128749

Location: KY-Louisville

Requisition ID: 128749