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Plan to Plan Service Spec I, II, III

Location:
JobFamily: Customer Service
Req #: PS59612
Date Posted: Dec 4, 2021

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Description:

Description

SHIFT: Day Job

SCHEDULE: Full-time

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.

Responsibilities:

The Plan to Plan Service Specialist is responsible for serving as a single point of contact in responding to all Plan to Plan claims inquiries and resolving related issues.  Plan to Plan Service Specialists may support Home (Representing Anthem members) which would require strong knowledge of Anthem member benefits, medical policy and authorization as well as JAA/TPA relations; Host (Representing Anthem providers) which would require strong knowledge of Anthem pricing, provider contracting/coding and medical pricing policy; or both of these lines of business. 

Primary duties for the Plan to Plan Service Specialist may include, but are not limited to:

  • Supports inquiries from other BCBS Plans that were unable to be resolved through normal channels.
  • Works with internal business partners (sales, member experience, claims, medical review, appeals, etc.) and external contacts within the other Blues plans to address all inter-Plan claims issues.  
  • Performs all aspects of customer service and manages adjustments, ITS processing, keying, rate negotiation, grievance and appeals, escalations, etc., in providing a seamless Blue customer experience.  
  • Understands all lines of business, including all subsets within the products, and all of the related systems.  
  • Resolves Plan to Plan emails and Blue 2 General inquiries.  
  • Requests and routes medical records to medical review units.  
  • Keys, processes and adjusts claims for all lines of business.  
  • Requires some supervision with claims processing/adjustments and inquiry resolution.  

In addition to the duties listed above, the Plan to Plan Service Specialist II may also be responsible for:

  • Fully proficient in all key areas; performs many complex functions.  
  • Requires limited supervision.
  • Handles special projects as assigned.  

In addition to the duties listed above, the Plan to Plan Service Specialist III may also be responsible for:

  • Fully proficient in all key areas; performs many complex functions and provides leadership to other Specialists. 
  • Actively seeks, evaluates and understands information needed to make effective decisions.  
  • Works independently.  
  • May represent the unit as a subject matter expert.  
  • Handles special projects as assigned.  

Qualifications

Minimum Requirements for Plan to Plan Service Specialist:

  • Requires a HS diploma or equivalent (GED)
  • 2 years of experience in an automated customer service or claims environment; or any combination of education and experience which would provide an equivalent background.

Minimum Requirements for Plan to Plan Service Specialist II:

  • Requires a HS diploma or equivalent (GED)
  • 3 years of experience in an automated customer service or claims environment, including inter-plan experience; or any combination of education and experience, which would provide an equivalent background.

Minimum Requirements for a Plan to Plan Specialist III:

  • Requires a HS diploma or equivalent (GED)
  • 5 years of experience in an automated customer service or claims environment
  • 2 years of inter-plan experience; or any combination of education and experience, which would provide an equivalent background.

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.

Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s 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

Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem. Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem.