Anthem Medical Management Specialist I/II- WAH- 133623 in Andover, Massachusetts
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. *
Medical Management Specialist I/II:
Responsible for providing non-clinical support to medical management operations, which includes handling more complex file reviews and inquiries from members and providers.
Primary duties may include, but are not limited to:
Gathers clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review).
Conducts initial review of files to determine appropriate action required. Maintains and updates tracking databases.
Prepares reports and documents all actions.
Responds to requests, calls or correspondence within scope.
Provides general program information to members and providers as requested. May review and assist with cases.
Acts as liaison between medical management operations and other internal departments to support ease of administration of medical benefits. May assist with case referral process. May collaborate with external community-based organizations to facilitate and coordinate care under the direction of an RN Case Manager.
Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information.
Requires a high school diploma
Requires 3 years of administrative and customer service experience with knowledge of managed care or Medicaid/Medicare concepts; or any combination of education and experience, which would provide an equivalent background.
Medical Terminology experience- Preferred
Microsoft Word and Excel experience- Preferred
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.
Equal Employment Opportunity Statement Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.
Title: Medical Management Specialist I/II- WAH- 133623
Requisition ID: 133623