Anthem Workers Compensation Network Relations Consultant

About the position

Responsibilities

• Conduct comprehensive reviews of provider disputes and ensure timely responses to clients and providers.
• Examine provider submitted bills for compliance with Workers' Compensation billing guidelines.
• Analyze claims and document determinations using required systems/tools.
• Research and stay updated on medical coding and billing issues, recommending policy modifications as needed.
• Collaborate with internal teams to review trends and suggest process improvements.
• Communicate investigation outcomes to providers and clients.
• Monitor and manage provider dispute inventory.
• Develop and implement new methods to enhance operations.
• Provide assistance regarding education, contract questions, and non-routine claim issues.
• Travel to worksite and other locations as necessary.

Requirements

• Bachelor's degree and a minimum of 3 years of customer service experience, including 2 years as a Network Management Rep, or equivalent education and experience.
• Minimum 5 years of workers' compensation experience, with knowledge of CA DWC OMFS and other State Workers Compensation Fee Schedules.

Nice-to-haves

• Proficiency in MS Office, WGS Pricing System, SPS Provider Data System, EPS Pricing System, AniTa Pricing System, HealthLink PeopleSoft system.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution
• Paid holidays
• Paid Time Off
• Medical, dental, and vision insurance
• Short and long term disability benefits
• Life insurance
• Wellness programs
• Financial education resources