Anthem Network Management Representative I/II/Sr - West Des Moines, IA - 132216 in West Des Moines, Iowa

/ 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 benefits companies and a Fortune Top 50 Company.

Network Management Representative I/II/Sr.

Provides quality, accessible and comprehensive services to the Anthem provider community. Provides assistance regarding education, contract questions and non-routine claim issues.

Primary duties may include, but are not limited to:

  • Coordinates communications process on such issues as administrative and medical policy, reimbursement and provider utilization patterns.

  • Develops, maintains, and enhances relations with providers to foster cooperative business relationships.

  • Coordinates prompt claims resolution through direct contact with providers and claims department.

  • Provides assistance with policy interpretation.

  • Researches, analyzes and recommends resolution for provider disputes as well as issues with billing and other practices.

  • Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery.

  • Tracks customer service patterns/trends and identifies training when appropriate.

  • Drafts training documents and conduct provider refresher training at onsite provider locations or by telephone.

  • Researches issues that may impact future provider negotiations or jeopardize network retention.

Requirements:

  • High School diploma

  • Minimum of 1-3 years of customer service experience

  • Minimum of 1 year of managed care experience

  • Or any combination of education and experience, which would provide an equivalent background.

  • Intermediate proficiency with Microsoft Excel / Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2016 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran. /

Job Provider Network Management

Title: Network Management Representative I/II/Sr - West Des Moines, IA - 132216

Location: IA-West Des Moines

Requisition ID: 132216