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Anthem, Inc. Claims Recovery Business Analyst II in Buffalo, New York


SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Beacon Health Options, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination. It’s 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.

For more than 30 years, Beacon Health Options has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 37 million people across all 50 states. At Beacon, our mission is to help people live their lives to the fullest potential. Beacon offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.

Location : New York, North Carolina & Virginia

Must reside within a commutable distance to the NY, NC or VA Anthem office

(Claims Recovery/Resolution BA II)

The Business Analyst II is responsible for translating basic business needs into application software requirements. The selected candidate will perform data mining, research claims, provider billing, Federal Wide Assurance (FWA) investigations, cost containment to meet the need of our clients.

Primary duties may include, but are not limited to:

  • Analyzes business needs to determine optimal means of meeting those needs.

  • Determines specific business application software requirements to address specific business needs.

  • Works with programming staff to ensure requirements will be incorporated into system design and testing.

  • Acts as liaison with users of the software to address questions/issues.

  • Perform data mining utilizing CPT, HCPCS, DRG, ICD-9, ICD-10, etc., to identify recovery opportunities.

  • Investigate, recover, and resolve all types of claims as well as recovery and resolution for health plans


Minimum Requirements:

Requires a BA/BS and minimum of 3 years related business analysis experience, or any combination of education and experience, which would provide an equivalent background.

Preferred Qualifications:

  • Able to commit to deliverables and maintain timely turnaround times.

  • Experience using Excel, Word

  • Experience using Tableau and/or Power BI a plus

  • Medical billing and/or claims processing experience is preferred

  • 2+ years of experience with data analysis, claims processing, provider billing, FWA investigations, cost containment, Medicare, Medicaid, MMP and/or MedSupp plans

  • Medical coding experience - CPT, HCPCS, ICD-9/10 coding

  • CPC or applicable professional designation a plus

    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 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.

    REQNUMBER: PS55988