Medical Review Analyst I

Anticipated End Date :

Position Title :

Medical Review Analyst I

Job Description :

MEDICAL REVIEW ANALYST I

Location : This role requires associates to be in-office 1 day per week fostering collaboration and connectivity while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work promoting a dynamic and adaptable workplace. Alternate locations may be considered.

Please note that per our policy on hybrid work candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment unless an accommodation is granted as required by law.

The MEDICAL REVIEW ANALYST I will be responsible for providing non-clinical review and analysis of non-complex Tier 1 post service medical claims.

How you will make an impact :

Utilizes guidelines and review tools to analyze assigned medical records and correspondence to route to appropriate imaging and routing applications.

Follows department guidelines and tools to conduct reviews.

Reviews analyzes and renders determinations on assigned Tier I requests.

Serves as a liaison between medical record management and / or service operations and other internal departments.

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

Minimum Requirements :

Requires a High School Diploma and a minimum of 4 years of internal company claims processing or customer service experience; or any combination of education and experience which would provide an equivalent background.

Experience with medical coding and medical terminology required.

Preferred Skills Capabilities and Experiences :

Associate degree is preferred.

Understanding of provider networks the medical management process internal business processes and proficiency with internal local technology preferred.

Job Level :

Non-Management Non-Exempt

Workshift :

1st Shift (United States of America)

Job Family : CLM >

Claims Support

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 Are

Elevance 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 Work

At 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.

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 and Influenza. 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 for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws including but not limited to the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Required Experience :

IC

Key Skills

Environmental Safety,Fashion Retail,C++,Arabic Faculty,BI

Employment Type : Full-Time

Experience : years

Vacancy : 1