Anthem, Inc. Medical Review Analyst II in Norfolk, Virginia
SHIFT: Day Job
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.
The Medical Review Analyst II is responsible for: • Providing non-clinical review and analysis of all non-complex and some complex Tier I post service medical claims • Primary duties may include, but are not limited to: Utilizes guidelines and review tools to analyze assigned claims and medical records to either approve or summarize and route to nursing and/or medical staff for review • Reviews, analyzes and renders determinations on assigned non-complex and some complex Tier I requests • Serves as a liaison between medical management and/or service operations and other internal departments • Serves as an internal resource for associates • Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information • Researches and responds to email inquiries from providers and in-house departments to ensure timely delivery of correspondence. • Prepares written correspondence that effectively communicates the company's position and satisfies all departmental requirements
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.
High school diploma
5 years of Anthem claims processing or customer service experience with managing complex claims, provider, or member issues; or any combination of education and experience, which would provide an equivalent background
Proficiency with medical coding and medical terminology required
Knowledge of provider networks, the medica
l management process, Anthem internal business processes, and proficiency with internal local technology required
strong written, problem-solving skills, and analytical skills
Be within 50 miles of a Norfolk location