Provider Escalations Analyst

Elevance Health; Deutschland; Hybrid; EUR 56.000 - 77.000; Vollzeit

Benefits dieser Stelle

Health insurance

Zusammenfassung

Elevance Health is seeking a Provider Escalations Analyst to manage Provider Issues Resolution (PIR) escalations across all lines of business and to resolve provider payment escalation requests, including communication of contracts plus medical and clinical policies.

The role focuses on remediation of high-dollar multi-claim issues, analysis of claim payments, and collaboration with internal and external partners to determine root causes and achieve appropriate resolutions.

Qualifikationen

• Minimum requirements include a high school diploma or GED with 6 years of claims research/issue resolution or reimbursement analysis in healthcare.
• Preferred: claims knowledge experience, WGS/CIW experience, and Excel/reporting knowledge.

Aufgaben

• Remediate high-dollar multi-claim issues by reviewing claim impact reports and initiating sweeps.
• Investigate outcomes of claim payments or denials for provider escalations across lines of business.
• Interpret benefits, policies, provider contracts, and adjudication guidelines to ensure proper resolution.
• Identify barriers and participate in process-improvement projects affecting medical policy, reimbursement, and provider utilization.
• Serve as a liaison with internal/external partners; communicate root causes and resolutions.

Kenntnisse

Claims knowledge

WGS / CIW

Excel reporting

Ausbildung

High school diploma or GED

Tools

Excel

Jobbeschreibung

Anticipated End Date:

2026-10-01

Position Title:

Provider Escalations Analyst

Job Description:

Provider Escalations Analyst

Virtual:

This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The Provider Escalations Analyst is responsible for Provider Issues Resolution (PIR) escalations across all lines of business and is responsible for the resolution of provider payment escalation requests and communication of contracts along with medical and clinical policies.

How you will make an impact:

• Remediate impacted high dollar multi claim issues (request and analyze claim impact reports & initiate sweeps), investigate the outcome of claim payment or denial for provider escalations through the PIR support process.
• May adjust claims for a specific line of business and market within guidelines to ensure proper adjudication, interpret benefits, policies and procedures, provider contracts, and adjudication of claims, analyze systems and processes that span across multiple operational area and claim systems.
• Recommend resolution for contract dispute, non-routine claim issues, billing questions and other practices.
• Identify barriers and participates in process improvement projects and coordinates communication processes on medical policy, reimbursement, and provider utilization patterns.
• May serve as a liaison with internal and external business partners.
• Collaborates with internal and external business partners to determine root cause and solve for appropriate resolution.

Minimum Requirements

• High school diploma or GED and a minimum of 6 years of claims research and/or issue resolution or analysis of reimbursement methodologies within the health care industry which would include internal and external customer service experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences

• Claims knowledge experience preferred.
• WGS / CIW experience preferred.
• Excel and reporting knowledge experience preferred.

Job Level:

Non-Management Non-Exempt

Workshift:

1st Shift (United States of America)

Job Family:

CLM > Provider Support

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

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.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

NOTE:

Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words - the job is posted until 3/13, not through 3/13.