Anthem, Inc. Plan to Plan Service Specialist I in Dearborn, Michigan
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.
Applicable to Colorado Applicants Only Annual Salary Range*: $33,600 - $50,400 Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. * The hourly or salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law. Job Description
Responsible for serving as a single point of contact in responding to all Plan to Plan claims inquiries and resolving related issues.
The Plan to Plan Service Specialists may support Home (Representing Anthem members) which would require strong knowledge of Anthem member benefits, medical policy and authorization as well as JAA/TPA relations; Host (Representing Anthem providers) which would require strong knowledge of Anthem pricing, provider contracting/coding and medical pricing policy; or both of these lines of business.
Primary duties may include, but are not limited to:
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 or GED • A composed individual able to multi-task, navigating multiple computer applications and working efficiently while communicating
• Must have a strong work ethic and sense of responsibility to your teammates and our members, demonstrated by the simplest things like being on time and available to meet member’s needs, to being accountable for commitments made to customers or others and ensuring follow-ups are completed
• Flexible and quick learner, willing to adapt to changing customer and business needs
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.