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 Apply tot his job