Jobs for People with MS: National MS Society

Plan to Plan Service Specialist I

Location : Ideal candidates will live within 50 miles of an Elevance Health PulsePoint office location.

The Plan to Plan Service Specialist I is responsible for serving as a single point of contact in responding to all Plan to Plan claims inquiries and resolving related issues. Plan to Plan Service Specialists may support Home (Representing members) which would require strong knowledge of member benefits, medical policy and authorization as well as JAA/TPA relations; Host (Representing providers) which would require strong knowledge of pricing, provider contracting/coding and medical pricing policy; or both of these lines of business.

How you will make an impact :

• Supports inquiries from other plans that were unable to be resolved through normal channels.

• Works with internal business partners (Provider Relations, customer service, account management, claims, appeals, etc.) and external contacts within the other plans to address all Plan claims or appeals issues.

• Performs EDI Reconciliation, keying higher-of rate adjustments, 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.

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

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

Minimum Requirements:

• Requires a HS diploma or equivalent and a minimum of 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.

Preferred Skills, Capabilities & Experiences :

• Healthcare related claims experience highly preferred.

• MS Office experience preferred

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $19.39/hr to $33.24/hr.

Locations: California; Nevada; Washington State;

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, nondiscriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

• The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.