Plan Design Specialist jobs in California

Job Description

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 EDS Reconciliation, keying higher 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.

Job Level :

Non-Management Non-Exempt

Workshift :

1st Shift (United States of America)

Job Family : CUS >

CUS >

Care Reps

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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

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.

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.

Last updated : 2024-06-07