Medical Review Analyst Lead

Description SHIFT: Day JobSCHEDULE: Full-timeMedical Review Analyst Lead United States, Virginia Medical Review Analyst Lead is responsible for leading a team who provides non-clinical review and analysis of Tier I post service medical claims. Primary duties may include, but are not limited to: Monitors work flow and makes assignments to ensure the correct team resource is utilized.

May also be responsible to provide non-clinical review and analysis of complex post service medical claims.

Ensures the team correctly utilizes guidelines and review tools to analyze assigned claims and medical records to either approve or summarize and route to nursing and/or medical staff for review.

Provides day-to-day work direction to and establishes work priorities for Medical Reviews Analysts.

Assists in training new associates and helps manager identify need for remedial training.

Reviews, analyzes and renders determinations on complex Tier I requests as needed.

Serves as a liaison between medical management and/or service operations and other internal departments, and may represent the department at internal and external meetings.

Utilizes expertise and serves as an internal resource for the department. Supports the department by leading assigned projects and initiatives.

Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information.

Qualifications Required qualifications: Requires a HS Diploma.

Minimum of 7 years of claims or customer service experience managing complex claims, provider, or member issues; or any combination of education and experience which would provide an equivalent background.

Experience of medical coding and medical terminology required.

Knowledge of provider networks, the medical management process, internal business processes, and expertise with internal local technology required.

Preferred qualifications:

BS/BA preferred.

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.

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.

Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem 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 ability@icareerhelp.com for assistance.

REQNUMBER: PS74768