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Plan to Plan Service Specialist I- Denver, CO- PS21784 at Anthem, Inc.

Posted in Admin - Clerical 30+ days ago.

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Type: Full-Time
Location: Denver, Colorado

Job Description:

Anthem, Inc. is the nation's leading health benefits company serving the needs of approximately 40 million medical members nationwide.

Responsible for serving as a single point of contact in responding to all Plan to

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.


Plan to Plan Service Specialist I


Serves as a single point of contact in responding to all Plan to Plan claims inquiries and resolving related issues. Primary duties may include, but are not limited to:

  • Works with internal business partners (sales, member services, claims, medical review, appeals, etc.) and external contacts within the other Blues plans to address all inter-Plan claims issues.

  • Performs all aspects of customer service and manages adjustments, ITS processing, keying, rate negotiation, grievance and appeals, escalations, etc., in providing a seamless Blue customer experience.

  • Understands all lines of business, including all subsets within the products, and all of the related systems.

  • Resolves Plan to Plan emails and Blue 2 General inquiries.

  • Requests and routes medical records to medical review units.

  • Keys, processes and adjusts claims for all lines of business.

  • Requires some supervision with claims processing/adjustments and inquiry resolution.

  • Requires a High School diploma or GED;

  • 2 years of experience in an automated customer service or claims environment;

  • or any combination of education and experience, which would provide an equivalent background.

  • Previous healthcare/medical experience required.

  • Prior knowledge within the Blue plan required.

  • WGS & CA Mainframe experience preferred. 

An Equal Opportunity Employer/Disability/Veteran