Lead Cust Care Rep/TPA Liaison

Elevance Health

This listing was posted on Broadbean.

Lead Cust Care Rep/TPA Liaison

Location:

Rancho Cordova, CA

Description:

Lead Customer Care Representative /TPA Liaison U-23This position is specific only to Leads that support Third Party Administrators (TPA) in the specialized unit.Resolves complex, difficult and/or non-routine submitted claims or customer service issues required by the TPA. May be assigned to take routine calls/process claims as needed. Interprets policy and contract eligibility. * Ensures that claims are settled satisfactorily and that favorable relationships are maintained * Advises and/or guides assigned department personnel in applying policies and procedures * Conducts client training on and off site and assigned department personnel as needed * Generates inventory reports for the TPA, Monitors claims aging reports and/or other multiple reports for the TPA client * Participates in conference calls with clients and/or travels to the clients for meetings/trainings. * Generates and responds to daily emails from the TPA clients requiring assistance. Provides data to TPAs regarding Grievance & Appeals, Arbitrations/Depositions as needed * Supports Implementation Specialists * Supports Local and Enterprise Projects for the development of new system/product development * Generates access IDs/Passwords. Conducts UAT testing Performs quality review of workperformed by assigned department personnel * Monitors department audit results to ensure quality goals are being met. * Monitors department workflow to ensure production plans are being met * Contacts customers (i.e. providers, brokers, TPAs, and other Anthem departments) during the course of review to clarify and/or gather additional information required to process claims and/or resolve inquiries * Assists in development of improved workflow and methods * Prepares department reports and request ad hoc reports as needed. Provides direct support for all TPA business * Handles escalated issues as assigned * Responsible for resolution of HART team issues * Conducts legal research as requested by the Anthem legal department. Assists supervisor with day-to-day operations of the departmentTwo (2) years' experience as an Anthem Sr. Customer Service Representative or three (3) years' experience as an Anthem Customer Service Representative, and meeting expectations for quality and quantity. This position will support CSR'S assigned to telephones, and claims examiners.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 AreElevance 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 WorkAt 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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.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. 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 may contact elevancehealthjobssupport@elevancehealth.comfor assistance.

Company:

Elevance Health

Posted:

November 13 on Broadbean

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Lead Cust Care Rep/TPA Liaison | Lead Cust Care Rep Tpa Liaison in Other Job Job at Elevance Healt1

Lead Cust Care Rep/TPA Liaison

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