Anthem, Inc. Network Management Representative in Miami, Florida
SHIFT: Day Job
Be part of an extraordinary team
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?
The Network Management Representative provides comprehensive services to the provider community through researching more complex provider issues.
How you will make an impact:
Serves as point of contact for other internal departments regarding provider issues that may impact provider satisfaction.
Researches and resolves the complex provider issues and appeals for prompt resolution.
Coordinates prompt claims resolution through direct contact with providers and claims department.
May perform periodic provider on-site visits.
Provides assistance with policy interpretation.
Researches, analyzes and recommends resolution of provider disputes, issues with billing, and other practices.
Assists providers with provider demographic changes as appropriate.
Responds to provider issues related to billing, pricing, policy, systems and reimbursements.
Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery.
Determines if providers were paid according to contracted terms.
Requires a High School diploma or GED equivalent
A minimum of 3 years of customer service experience; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities, and Experiences:
Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills strongly preferred.
Proficient in Excel preferred.
FACETS experience preferred.
Previous provider/managed care experience strongly preferred.
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 Anthem. 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 Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. 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.antheminc.com. Anthem 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.