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Provider Pay Reconsider Analyst I/II- Nationwide- PS27237

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Job Details
Job Order Number
JC148147451
Company Name
Anthem, Inc
Physical Address

Schaumburg, IL 60173
Job Description

Provider Pay Reconsider Analyst I/II- Nationwide- PS27237

Location: United States

Requisition #: PS27237

Post Date: Nov 17, 2019

Your 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/II

LEVEL 1

This 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 2

This 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/Veteran

LEVEL 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


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