/ 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 benefits companies and a Fortune Top 50 Company.
Plan to Plan Service Specialist I:
Serves as a single point of contact in responding to all Plan to Plan claims inquiries and resolving related issues. Primary duties may include, but are not limited to:
Works with internal business partners (sales, member services, 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.
Requires some supervision with claims processing/adjustments and inquiry resolution.
Requires a HS diploma or GED; 2 years of experience in an automated customer service or claims environment; or any combination of education and experience, which would provide an equivalent background.
Prior knowledge within the Blue plan preferred.
WGS & CCB experience preferred.
Price N' Ship (PNS) experience preferred.
Call Center experience strongly preferred.
Adjustment claims experience preferred.
Experience working in a team environment preferred.
Experience working in high pressure environment preferred.
Excellent multitasking skills preferred.
Critical thinking skills required.
No telecommuting available.
/ Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2016 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran. /
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Equal Employment Opportunity Statement
Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.
Title: Plan to Plan Service Specialist I - Denver, CO - 134547
Requisition ID: 134547
A little about us:
We have shared values and a similar mission.