Remote Senior Provider Escalations Specialist

The Elevance Health Companies, Inc.; Indianapolis (IN); On-site; USD 80,000 - 110,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision care

401(k) + match

Stock purchase plan

Life insurance

Paid holidays

Paid time off

Wellness programs

Incentive bonus programs

Job summary

Elevance Health is seeking a Senior Provider Escalations Analyst to manage PIR escalations across lines of business and resolve provider payment issues. The role is virtual full-time with required in-person training and occasional office visits for onboarding.

You will interpret contracts and medical policies to ensure accurate adjudication and coordinate with partners for effective resolutions. Requires a high school diploma or GED and 8+ years in claims research or reimbursement analysis;

Qualifications

• High school diploma or GED required with 8+ years in claims research or reimbursement analysis.
• Experience in independent dispute resolution strongly preferred.
• Proven ability to interpret contracts, policies and provider agreements.

Responsibilities

• Remediate and analyze provider escalations across lines of business.
• Investigate claim payment or denial outcomes for high-visibility escalations.
• Adjust complex claims and rekey/reopen online as needed within guidelines.
• Interpret benefits, policies and contracts for proper adjudication.
• Collaborate with partners to determine root causes and implement resolutions.
• Mentor provider escalation analysts and coordinate UAT and project work.

Skills

Claims research

Escalation handling

Root cause analysis

Education

High school diploma or GED

Job description

Elevance Health is seeking a Senior Provider Escalations Analyst to manage PIR escalations across lines of business and resolve provider payment issues. The role is virtual full-time with required in-person training and occasional office visits for onboarding.

You will interpret contracts and medical policies to ensure accurate adjudication and coordinate with partners for effective resolutions. Requires a high school diploma or GED and 8+ years in claims research or reimbursement analysis;