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Medicaid Claims Resolution Analyst (Indiana HIPMedicaid Claims Experience) - Work From Home(Indianapolis Preferred) - PS11840

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PS11840 Requisition #
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Your Talent. Our Vision. At Anthem Blue Cross and Blue Shield, a proud member of the Anthem, Inc. family of companies,  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. 

 

Work Location: Remote; however, Indianapolis, IN is preferred.

 

The Claims Resolution Analyst is 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.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

  • 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.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

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Health Care Analytics

The Health Care Analytics (HCA) team focuses on transforming the way data is used within the health care industry. They provide strategic analysis that impacts business decisions, improves efficiency and drives innovation.

As we expand our technology and analytics capabilities, we are searching for associates that have a passion for analytics and the drive to pave the way in a growing industry.

Career opportunities are available in the following areas:

  • Strategy and planning: Ensures strategic alignment between HCA projects and the organization's broader goals. Also integrates analytics strategy into the execution process, including program management, project controls, communications and vendor oversight.
  • Operations: This department houses the HCA shared-services functions including project financial controls and estimations, demand management, user acceptance testing, and coordination and release management.
  • Customer management analytics: Provides accurate, timely and reliable delivery of client reports, which include data analyses, insights and other information that demonstrates Anthem’s value as a business partner.
  • Financial management analytics: Works closely with HCA leaders and other Anthem management to provide support to the finance and accounting teams through financial reporting systems.
  • Member management analytics: This team is responsible for the risk adjustment program and analytics, the member management program, predictive analytics and member management analytic products management.
  • Provider management analytics: Manages Anthem’s unit cost trend, provider contract modeling, network profiling, payment innovation analytic solutions, and other analytics that enable provider collaboration strategies.
  • Research, development and transformational analytics: Works with senior leaders to manage implementations, new product development and provides acquisition support.

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