Anthem, Inc. Benefits Analyst II in Miami, Florida
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.
Benefits Analyst II
This position supports the testing of benefit configuration and/or oversees and manages all Medicaid and Medicare markets; researching inquiries to resolution, new implementations and maintenance projects, and supporting external claims, regional state operations, and regional teams; validating the accuracy of benefits against claims payments to identify areas of opportunities to reduce defects.
Primary duties may include, but are not limited to:
Researches and responds to inquiries from various departments.
Oversees the execution of account management and retention strategy for accounts.
Assists Health Plans to assure that all aspects of account service run smoothly
Creates and publishes periodic reports, as well as any necessary ad hoc reports
Determines specific business application software requirements to address complex business needs.
Establishes and maintains collaborative relationships with key business partners
Identifies best approach to code/develop benefits to achieve optimum adjudication levels
Works with configuration staff to ensure requirements will be incorporated into system design and testing.
Research and analyze Business Requirement Docs: (BRD, RCD and HLBR).
Troubleshoot issues to resolve problems, and provide timely follow-up on identified issues.
Ensure policies and edits do not conflict with Federal and state mandates.
Research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy
Works to ensure business needs are met
Subject matter expertise knowledge level of business processes.
Ability to participate to attend meetings teams and provide updates.
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.
Requires a High School diploma or GED; BA/BS degree preferred.
Up to 3 years experience in claims processing, previous medical health care or analytical experience;
3-5 years benefit coding experience; or
Any combination of education and experience that would provide an equivalent background.
Ability to initiate or assist with testing of changes as it relates to the coding of benefits
Query development and data analysis skills preferred (using any database technology)
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 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.