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Description SHIFT: Day JobSCHEDULE: Full-timeResponsible for Provider Issues Resolution (PIR) escalations across all lines of business and is responsible for the resolution of provider payment escalation requests and communication of contracts along with Anthem's medical and clinical policies.Primary duties include but are not limited to:Remediate impacted high dollar multi claim issues (request and analyze claim impact reports & initiate sweeps)
Investigate the outcome of claim payment or denial
Adjusts complex claims for a specific line of business and market
Adjust voids
Rekey and reopen claims on-line within guidelines to ensure proper adjudication
Interpret benefits, policies and procedures, provider contracts, and adjudication of claims
Analyze systems and processes that span across multiple operational area and claim systems
Recommend resolution for contract dispute, non-routine claim issues, billing questions and other practices
Identify barriers and facilitates process improvement projects and coordinates communication processes on medical policy, reimbursement, and provider utilization patterns
May serve as a liaison and SME with internal and external business partners
Collaborates with internal and external business partners to determine root cause and solve for appropriate resolution
Qualifications Requirements:High school diploma or GED
Minimum of 6 years of claims research/customer service experience 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
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.REQNUMBER: PS61036-Kentucky
Vacancy expired!