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  • ID
    #5090752
  • Salary
    TBD
  • Source
    Anthem, Inc.
  • Date
    2020-10-21
  • Deadline
    2020-12-19
 
Full-time

Vacancy expired!

Description SHIFT: Day JobSCHEDULE: Full-timeYour Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and 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 andtogether 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.Medical Review Analyst I/IILocations: Work@home position but must be within a commutable distance to an Anthem office.REQUIREMENTS:Responsible to provide non-clinical review and analysis of all non-complex and some complex Tier I post service medical claims. Primary duties may include, but are not limited to:Utilizes guidelines and review tools to analyze assigned claims and medical records to either approve or summarize and route to nursing and/or medical staff for review.

Reviews, analyzes and renders determinations on assigned non-complex and some complex Tier I requests.

Serves as a liaison between medical management and/or service operations and other internal departments.

Serves as an internal resource for associates.

Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information.

AnEqualOpportunityEmployer/Disability/VeteranQualifications QUALIFICATIONS:Requires a high school diploma

3-5 years of Anthem claims processing or customer service experience with managing complex claims, provider, or member issues; or any combination of education and experience, which would provide an equivalent background.

Proficiency with medical coding and medical terminology required. Knowledge of provider networks, the medical management process, Anthem internal business processes, and proficiency with internal local technology required.

BA/BS preferred.

REQNUMBER: PS40357

Vacancy expired!

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