Anthem Claims Resolution Analyst / Sr. - West Virginia Medicaid - Anywhere in US (131098) in Rancho Cordova, California

/ 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 willdrive 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.


  • Location: * This position will allow you to work from home anywhere in the United States. Applicants who reside near Charleston, WV are a plus.


  • Please note: * This position may be filled at either the Claims Resolution Analyst or Claims Resolution Analyst Sr. level. Manager will determine level based upon the selected applicant's skillset relative to the qualifications listed for this position.

  • Claims Resolution Analyst * orClaims Resolution Analyst Sr. is responsible for coordinating the resolution of claims issues by actively researching and analyzing systems and processes that span across multiple operational areas. Primary duties may include, but are not limited to:

    • Investigates and facilitates the resolution of claims issues, including incorrectly paid claims, by working with multiple operational areas and health plans and analyzing the systems and processes involved in member enrollment, provider information management, benefits configuration and/or claims processing.

    • Identifies the interdependencies of the resolution of claims errors on other activities within operations.

    • Assists in the reviews of state or federal complaints related to claims.

    • Coordinates the efforts of several internal departments to determine appropriate resolution of issues within strict timelines.

    • Interacts with network providers and health plans regularly to manage customer expectations, communicate risks and status updates, and ensure issues are fully resolved.

    • Performs claims and trend analysis, ensures supporting documentation is accurate and obtains necessary approvals to close out claims issues. / /

    TheClaims Resolution Analyst Sr.is also responsible for researching, analyzing, documenting and coordinating the resolution of escalated and/or complex claims issues that span across multiple operational areas and requires expert knowledge of all systems, tools and processes. Primary duties in addition to the duties of the Claims Resolution Analyst may include, but are not limited to:

    • Provide project team leadership.

    • Coordinate the identification and resolution of root causes involving configuration, claims and/or contracting activities.

    • Creating Microsoft Access Database

    The Claims Resolution Analyst and Sr require:

    • BA/BS; 3 years of claims research and/or issue resolution or analysis of reimbursement methodologies within the health care industry (5 years for the Sr level); or any combination of education and experience, which would provide an equivalent background.

    Other requirements include:

    • Experience processing Medicaid Claims in the Managed Care industry.

    • Expert using WGS.

    • Experience with claims issues and analysis preferred.

/ Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 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 Claims

Title: Claims Resolution Analyst / Sr. - West Virginia Medicaid - Anywhere in US (131098)

Location: CA-Rancho Cordova

Other Locations: WV-Charleston

Requisition ID: 131098