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Job Details

Facets/QNXT Provider Reimburse Admin - Any Anthem location or remote - PS18298

Company name
Anthem, Inc.

Middletown, IN, United States

Employment Type

Posted on
Mar 08,2019

Valid Through
Jun 21,2019

Apply for this job


(Facets/QNXT) Provider Reimburse Admin - (Any Anthem location or remote) - PS18298

Location: United States


Field: Provider Network Management

Requisition #: PS18298

Post Date: 8 hours ago

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re

creating greater care for our members, greater value for our customers, and

greater health for our communities. Join us and together we will drive thefuture 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.

The Provider Reimbursement Administrator ensures accurate

adjudication of claims by conducting root cause research of potential pricing

and benefit configuration issues and provider appeals. Research includes, but is not limited to review of core

configuration, provider contracts, business requirements documentation, medical

policies, reimbursement policies, and clinical editing policies. Primary duties may include, but are not limited


Conducting in-depth research into claims inquiries andprovider appeals to determine root cause related to pricing and benefitconfiguration.

Working with internal partners to confirm/validatehistorical configuration design and implementation.

Working with internal departments on workflow developmentand business process improvements.

Utilizing advanced critical thinking and analytical skillsto identify trends in configuration issues across markets and lines ofbusiness.

BA/BS degree; 2 years related experience; or anycombination of education and experience, which would provide an equivalentbackground

Advanced critical thinking / analytical / problem solvingskills required

FACETS or QNXTexperience required

SQL or Access or SAS experience required; the ability toquery and build reports

Experience communicating and presenting data to variousaudience members at all levels required

Experience facilitating meetingspreferred

Demonstrated knowledge and experience in the theseareas is required for the role and must be included in the related or equivalentexperience to meet the basic qualifications listed above.

Please note, this position may be located in any Anthem

site location or remote.

Anthem, Inc. is ranked as one of America’s MostAdmired Companies among health insurers by Fortune magazine and is a 2018DiversityInc magazine Top 50 Company for Diversity. To learn more about ourcompany and apply, please visit us at An EqualOpportunity Employer/Disability/Veteran

Company info

Anthem, Inc.
Website :

Company Profile
The company was formed when WellPoint Health Networks Inc. and Anthem, Inc. merged in 2004 to become the nation's leading health benefits company. The parent company originally assumed the WellPoint, Inc. name at the time of the merger. In December 2014, WellPoint, Inc. changed its corporate name to Anthem, Inc. The Anthem brand is built on a foundation of trust – it’s the name consumers are most familiar with as a trusted health care partner through our affiliated health plans. Anthem, Inc. is one of the largest health benefits companies in the United States. Through its affiliated health plans, Anthem companies deliver a number of leading health benefit solutions through a broad portfolio of integrated health care plans and related services, along with a wide range of specialty products such as life and disability insurance benefits, dental, vision, behavioral health benefit services, as well as long term care insurance and flexible spending accounts. Headquartered in Indianapolis, Indiana, Anthem, Inc. is an independent licensee of the Blue Cross and Blue Shield Association serving members in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin; and specialty plan members in other states.

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