Senior Provider Escalations Analyst

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🔥 0 minutes ago

🐊 Florida, North Carolina, +1 more states – Remote

🐊 Florida – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote

⏰ Full Time

🟠 Senior

🧐 Analyst

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

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Elevance Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 B2B

Healthcare • Healthcare Insurance • B2B

Elevance Health is transforming from a traditional health benefits organization into a lifetime trusted health partner, driven by a bold purpose to improve the health of humanity. With nearly 100,000 associates, they serve over 118 million people and utilize an integrated whole health approach supported by industry-leading capabilities and a digital health platform. Their mission includes redefining health, reimagining the health system, and strengthening communities.

📋 Description

• Remediate impacted multi-claim issues by requesting and analyzing claim impact reports and initiating sweeps • Investigate claim payment or denial outcomes for high-visibility provider escalations through PIR, regulatory, legal, or presidential escalation channels • Adjust complex claims for specific lines of business and markets • Adjust voids, rekey, and reopen claims online within guidelines • Interpret benefits, policies and procedures, provider contracts, and claims adjudication • Analyze systems and processes spanning multiple operational areas and claim systems • Recommend resolutions for contract disputes, non-routine claim issues, billing questions, and other practices • Identify barriers and facilitate process improvement projects • Coordinate communications regarding medical policy, reimbursement, and provider utilization patterns • Serve as a liaison and subject matter expert with internal and external business partners • Mentor and train provider escalation analysts • Coordinate UAT testing and other project work • Collaborate with internal and external business partners to determine root causes and resolve issues

🎯 Requirements

• High school diploma or GED • Minimum of 8 years of claims research and/or issue resolution or analysis of reimbursement methodologies within the health care industry • Internal and external customer service experience • Any combination of education and experience providing an equivalent background • Experience in independent dispute resolution strongly preferred

🏖️ Benefits

• merit increases • paid holidays • Paid Time Off • incentive bonus programs • medical benefits • dental benefits • vision benefits • short-term disability benefits • long-term disability benefits • 401(k) + match • stock purchase plan • life insurance • wellness programs • financial education resources • Virtual full-time work with required in-person training sessions • Flexible work-life integration and autonomy