Business Analyst II/III - Any Anthem Office or Remote - PS11736
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 benefits companies and a Fortune Top 50 Company.
Business Analyst II or Business Analyst III
This position may be filled at either the Business Analyst II or Business Analyst III. Manager will determine level based upon the selected applicant’s skill set relative to the qualifications listed for this position
Location: Any Anthem Location or Remote
- Conducts the analysis of claims payments to identify areas of claim overpayment recovery opportunities.
- Validates overpayment opportunities and works with the BCs to ensure business requirements are incorporated into query design and testing.
- Serves as the liaison for business and IT to translate complex business needs to application software for overpayment identification.
- Determines specific business application software requirements to address complex business needs.
- Completes all documentation to support work flow and reporting.
- Completes testing on claims identified as potential overpayments.
- Collaborates with the claims validation team to approve concepts for recovery.
- Identifies or validates overpayment recovery opportunities.
- May provide requested direction and guidance to team members and serve as an expert for the team.
Requirements: Business Analyst II or Business Analyst III dependent on experience:
- This position is mid-level analyst with more recovery experience.
- BS/BA degree preferred
- 3 - 7 or more years related recovery analysis experience, or any combination of education and experience, which would provide an equivalent background.
- WGS/Commercial claims experience required.
- 3 to 5 years claims processing experience on multiple claims processing systems
- State specific rules & regulations for multiple states
- Ability to interpret provider contracts for professional and facility providers
- Reimbursement policies
- Member contract benefits
- Programs adjunct to system processing
- Blue Squared knowledge
- Medicare and Medicaid claims experience a plus
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.