Anthem, Inc. Plan to Plan Service Specialist I in Jefferson City, Missouri
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.
Primary duties may include, but are not limited to:
Responsible for serving as a single point of contact in responding to all Plan to Plan claims inquiries and resolving related issues.
Supports inquiries from other BCBS Plans that were unable to be resolved through normal channels.
Works with internal business partners (sales, member experience, 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 equivalent; 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.
Requirements: • High school diploma, GED, or Equivalent
- Previous work experience in call center or customer service environment within the managed care industry
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. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s 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.
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