Responsible for serving as a single point of contact in responding to all Plan to Plan claims inquiries and resolving related issues. Plan to Plan Service Specialists may support Home (Representing members) which would require strong knowledge of member benefits, medical policy and authorization as well as JAA/TPA relations; Host (Representing providers) which would require strong knowledge of 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. Fully proficient in all key areas; performs many complex functions.
- Requires limited supervision.
- Handles special projects as assigned.
- Requires a HS diploma or equivalent and a minimum of 3 years of experience in an automated customer service or claims environment, including inter-plan experience; or any combination of education and experience which would provide an equivalent background.
Applicable to Colorado Applicants Only:
Colorado Hourly Pay Range*: $18.08 - $22.60/ hr. 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.
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
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.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealthinc.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact email@example.com for assistance.