Network Management Rep Sr - Woodland Hills, CA (Office-based) - PS23433
Woodland Hills, CA

Job Description

Your Talent. Our Vision. At Anthem, Inc., it's a powerful combination, and the foundation upon which we're creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.

Provides comprehensive services to the provider community through researching the most complex provider issues. Serves as mentor to new and existing associates.

Primary duties may include, but are not limited to:

* Serves as knowledge and resource expert regarding provider issues that may impact provider satisfaction.
* Researches and resolves the most complex provider issues and appeals for prompt resolution.
* Processes and analyzes provider applications for consideration in the PPO Commercial Network.


* Provides assistance with policy interpretation.
* Researches, analyzes and recommends resolution of provider disputes as well as issues with billing and other practices.
* Determines if providers were paid according to contracted terms.
* Works on special projects.
* Assists in developing policies and practices and audits work.
* Collects data and compiles reports.
* Requires a H.S. diploma; 5 years customer service experience; 2 years experience as a Network Management Rep; or any combination of education and experience, which would provide an equivalent background.
* For URAC accredited areas the following applies:
* Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
* At least 1 year of experience in the healthcare field preferred.
* Basic Excel experience preferred.
* Strong computer skills required.
* Must be a team player.
* Must be able to handle conflict resolution.
* At least 1 year of customer service experience preferred.
* An Equal Opportunity Employer/Disability/Veteran

Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.