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Claims Resolution Analyst or S...

Monster
 
 
 
 

Job Summary

Company
Anthem
Location
Eagan, MN
Industries
Other/Not Classified
Job Type
Full Time
Employee
Career Level
Experienced (Non-Manager)
Job Reference Code
4298_PS2794

Claims Resolution Analyst or Senior Analyst Job Family - Eagan, MN or Remote option for MN Intern...

About the Job

Description
Your Talent. Our Vision. At Anthem, Inc., the Government Business Division is focused on serving Medicaid, Medicare and uninsured individuals. Our commitment and focus on government health programs is the foundation upon which we're creating better care for our members, greater value for our customers and better health for our communities. Join us and together we will drive the future of health care.
Join one of the fastest growing businesses in a company with the largest and most successful Medicaid business in the nation. The associate in this position will be supporting members enrolled in the Minnesota Medicaid Program.

Claims Resolution Analyst or Sr. Job Family - Eagan, MN PS2794

Work Location: Eagan, Minnesota in office for both internal and external candidates (preferred) but remote possibility for MN Internal Anthem Associates Only.
Claims Resolution Analyst:
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.
* 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.
Claims Resolutions Analyst Senior:
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. Primary duties may include, but are not limited to:
* When appropriate, the incumbent will provide project team leadership.
* Coordinate the identification and resolution of root causes involving configuration, claims and/or contracting activities.
Qualifications
Claims Resolution Analyst:
* 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.

Preferred:
* Previous experience adjusting and processing claims.
* Previous experience reviewing claims and making reimbursement determinations.
* Previous experience resolving provider claims and reimburse disputes.
* Previous experience resolving claim pricing issues.
* Healthcare/Payer Experience.
* Experience using new tools such as Nextgens, Pega and etc.


Claims Resolution Analyst Senior:
* Requires a BA/BS; 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.

Preferred:
* Previous experience adjusting and processing claims.
* Previous experience reviewing claims and making reimbursement determinations.
* Previous experience resolving provider claims and reimburse disputes.
* Previous experience resolving claim pricing issues.
* Healthcare/Payer Experience.
* Experience using new tools such as Nextgens, Pega and etc.

Note: This position may be filled at either the Claims Resolution Analyst or Claims Resolution Analyst Senior Level. The manager will determine level based upon the selected applicant's skillset relative to the qualifications listed for this position.

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 at antheminc.com/careers. EOE. M/F/Disability/Veteran.


 

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