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Anthem, Inc. Finance Operation Recovery Specialist II in Richmond, Virginia

Description

SHIFT: Day Job

SCHEDULE: Full-time

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 at one of America's leading health care companies and a Fortune Top 50 Company.

Finance Operation Recovery Specialist II

  • Responsible for serving as a single point of contact in responding to all Plan to Plan claims inquiries and resolving related issues.

  • Plan to Plan Service Specialists may support Home (Representing Anthem members) which would require strong knowledge of Anthem member benefits, medical policy and authorization as well as JAA/TPA relations; Host (Representing Anthem providers) which would require strong knowledge of Anthem pricing, provider contracting/coding and medical pricing policy; or both of these lines of business.

  • Primary duties may include, but are not limited to: Supports inquiries from other BCBS Plans that were unable to be resolved through normal channels.

  • Works with internal business partners (sales, member experience, claims, medical review, appeals, etc.) and external contacts within the other Blues plans to address all inter-Plan claims issues.

  • Performs all aspects of customer service and manages adjustments, ITS processing, keying, rate negotiation, grievance and appeals, escalations, etc., in providing a seamless Blue customer experience.

  • Understands all lines of business, including all subsets within the products, and all of the related systems.

  • Resolves Plan to Plan emails and Blue 2 General inquiries.

  • Requests and routes medical records to medical review units.

  • Keys, processes and adjusts claims for all lines of business.

  • Fully proficient in all key areas; performs many complex functions and provides leadership to other Specialists.

  • Actively seeks, evaluates and understands information needed to make effective decisions.

  • Works independently.

  • May represent the unit as a subject matter expert.

  • Handles special projects as assigned.

Qualifications

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 at one of America's leading health care companies and a Fortune Top 50 Company.

Requirements Finance Operation Recovery Specialist II:

  • High School diploma or equivalent and a minimum of 5 years of experience in an automated customer service or claims environment and 2 years of inter-plan experience; or any combination of education and experience which would provide an equivalent background.

Preferred Qualifications:

  • AA/AS or higher level degree preferred.

    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. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. 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. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

    REQNUMBER: PS65640-Richmond-Richmond

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