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Claims Resolution Analyst - Re...

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Job Summary

Company
Anthem
Location
New York, NY
Industries
Other/Not Classified
Job Type
Full Time
Employee
Career Level
Experienced (Non-Manager)
Job Reference Code
4298_PS3127

Claims Resolution Analyst - Remote in NYC - PS3127

About the Job

Description

Your Talent. Our Vision. At Empire Blue Cross Blue Shield, a proud member of the Anthem, Inc. family of companies, 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.

Claims Resolution Analyst - Remote Opportunity - Must reside in NYC area

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

Primary duties may include, but are not limited to:

  • 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.

Qualifications
Qualifications:
  • Requires a BA/BS; 3 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.
  • Proficient knowledge and experience with Microsoft Excel required.
  • Knowledge of internal systems such as Facets, NextGen 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 and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.

 

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