Title: Plan to Plan Service Specialist III

Location: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.

The Plan to Plan Service Specialist III will be 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 BCBS Plans that were unable to be resolved through normal channels.

• Works with internal business partners (sales, member experience, 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.

• Fully proficient in all key areas; performs many complex functions and provides leadership to other Specialists.

• Actively seeks, evaluates and understands information needed to make effective decisions.

• Works independently.

• May represent the unit as a subject matter expert.

• Handles special projects as assigned.

Minimum Requirements

• Requires a HS diploma or equivalent and a minimum of 5 years of experience in an automated customer service or claims environment.

• 2 years of inter-plan experience; or any combination of education and experience which would provide an equivalent background.

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 elevancehealthjobssupport@elevancehealth.com for assistance.