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Business Analyst II (Claims An...

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Job Summary

Company
Anthem
Location
Tampa, FL
Industries
Other/Not Classified
Job Type
Full Time
Employee
Career Level
Experienced (Non-Manager)
Job Reference Code
4298_PS4155

Business Analyst II (Claims Analyst) - Florida - PS4155

About the Job

Description

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.


Location: The position is available in either the Tampa, Miami or Plantation, FL office location.

Business Analyst II (Claims Analyst) - Florida - PS4155

The Business Analyst II 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.

PRIMARY RESPONSIBILITIES:

  • 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.
  • Recommends new or modified processes and procedures to reduce claims errors, taking into consideration business requirements and system limitations.
  • Performs user acceptance testing to ensure new contracts are loaded correctly and system modifications are accurate.
  • Performs other duties as assigned.

Qualifications

Requires:

  • Bachelors degree or equivalent related experience
  • 5 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 experience adjusting and processing claims
  • Previous expeirence reviewing claims and making reimbursement determinations
  • Previous experience resolving provider claims and reimburse disputes
  • Previous experience resolving claim pricing issues
  • Healthcare/Payer Experience

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 and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.


 

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