Anthem Provider Reimburse Admin Sr – Root Cause Research - Nationwide (Remote Work Available) - PS6315 in Mason, Ohio

Provider Reimburse Admin Sr – Root Cause Research - Nationwide (Remote Work Available) - PS6315


Location: United States

Field: Provider Network Management

Requisition #: PS6315

Post Date: 3 days ago

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 atone of America's leading health benefits companies and a Fortune Top 50 Company.

The Provider Reimbursement Administrator Sr. (open to remote work) ensures accurate adjudication of claims by conducting root cause research of potential pricing and benefit configuration issues and provider appeals. Research includes, but is not limited to review of core configuration, provider contracts, business requirements documentation, medical policies, reimbursement policies, and clinical editing policies.

Primary duties may include, but are not limited to:

  • Conducting in-depth research into claims inquiries and provider appeals to determine root cause related to pricing and benefit configuration.

  • Working with internal partners to confirm/validate historical configuration design and implementation.

  • Working with internal departments on workflow development and business process improvements.

  • Utilizing advanced critical thinking and analytical skills to identify trends in configuration issues across markets and lines of business.

  • BA/BS degree; 4-6 years related experience; or any combination of education and experience, which would provide an equivalent background

  • Advanced critical thinking / analytical skills required

  • FACETS experience required

  • SQL or Access experience required; the ability to query and build reports

  • Experience communicating and presenting data to various audience members at all levels required

  • Experience facilitating meetings 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 EOE. M/F/Disability/Veteran.