Anthem, Inc. Network Management Representative in Mendota Heights, Minnesota
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.
Provides comprehensive services to the provider community through researching more complex provider issues.
Primary duties may include, but are not limited to:
Serves as point of contact for other internal departments regarding provider issues that may impact provider satisfaction.
Researches and resolves the complex provider issues and appeals for prompt resolution.
Coordinates prompt claims resolution through direct contact with providers and claims department.
May perform periodic provider on-site visits.
Provides assistance with policy interpretation.
Researches, analyzes and recommends resolution of provider disputes, issues with billing, and other practices.
Assists providers with provider demographic changes as appropriate.
Responds to provider issues related to billing, pricing, policy, systems and reimbursements.
Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery.
Determines if providers were paid according to contracted terms.
Requires a H.S. diploma; 3 years of customer service experience; or any combination of education and experience, which would provide an equivalent background.
Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
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. Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.