Elevance Health - Miami, FL
posted 4 days ago
Full-time - Entry Level
Hybrid - Miami, FL
Insurance Carriers and Related Activities
About the position
The Provider Payment Appeal Analyst I is responsible for supporting the Payment Dispute process across all lines of business and is specifically responsible for the resolution of Provider Payment Appeal requests. This position will be remote, but candidates must be located within 50 miles of an Elevance Health PulsePoint.
Responsibilities
- Reviews and analyzes provider requests to investigate the outcome of a Reconsideration.
- Considers all information when determining whether to uphold or overturn primary decision.
- Works with various departments including Provider Solutions and Health Plan Operations leadership when necessary, to determine root cause and appropriate resolution.
- Must work with Claims Operations to remediate impacted claims.
Requirements
- Requires a HS diploma or GED and a minimum of 3 years of claims research and/or issue resolution or analysis of reimbursement methodologies within the health care industry; or any combination of education and experience which would provide an equivalent background.
Nice-to-haves
- Experience with data analytics preferred.
- Ability to research preferred.
- Bachelor's degree preferred.
Benefits
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical benefits
- Dental benefits
- Vision benefits
- Short and long term disability benefits
- 401(k) + match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
