Analista de Controles Internos contribuindo para a gestão de riscos e controles da companhia. Auxiliar na evolução da maturidade em gestão de riscos e apoiar auditorias internas e externas.
About the role
- Provider Payment Appeal Analyst resolving provider payment disputes and coordinating remediation across operations at Elevance Health.
Responsibilities
- Support the Payment Dispute process across all lines of business and resolve Provider Payment Appeal requests
- Review and analyze provider requests to investigate the outcome of a Reconsideration
- Consider all information when determining whether to uphold or overturn primary decision
- Work with various departments including Provider Solutions and Health Plan Operations leadership to determine root cause and appropriate resolution
- Work with Claims Operations to remediate impacted claims
- Virtual role with required in-person training sessions and potential hybrid onsite requirements per company policy
Requirements
- HS diploma or GED
- Minimum of 3 years of claims research and/or issue resolution or analysis of reimbursement methodologies within the health care industry
- or any combination of education and experience which would provide an equivalent background
- Bachelor's degree preferred
- Claims processing experience preferred
- WGS/CI&W experience preferred
- Must be within a reasonable commuting distance from the posting location(s) unless an accommodation is granted as required by law
- Candidates in certain patient/member-facing roles required to become vaccinated against COVID-19 and Influenza (offer rescinded if not vaccinated unless acceptable explanation)
Benefits
- a comprehensive benefits package
- incentive and recognition programs
- equity stock purchase and 401k contribution
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical, dental, vision
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
Job title
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