Medical Review Analyst II

Elevance Health•Norfolk, VA

1d•$23 - $41•Remote

About The Position

The Medical Review Analyst II will be responsible to provide non-clinical review and analysis of all non-complex and some complex Tier I post service medical claims. This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. This position works standard working hours: 8am to 5pm, but not earlier than 8am EST.

Requirements

Requires a HS Diploma or equivalent and a minimum of 5 years of claims processing or customer service experience with managing complex claims, provider, or member issues; or any combination of education and experience which would provide an equivalent background.
Experience with medical coding and medical terminology required.

Nice To Haves

Associate Degree preferred.
Understanding of provider networks, the medical record management processes, internal business processes, and proficiency with internal local technology preferred.

Responsibilities

Utilizes guidelines and review tools to analyze assigned claims and medical records to either approve or summarize and route to nursing and/or medical staff for review.
Reviews, analyzes and renders determinations on assigned non-complex and some complex Tier I requests.
Serves as a liaison between medical management and/or service operations and other internal departments.
Serves as an internal resource for associates.
Retrieval of physical copies of facility documents delivered to the Elevance Health facility.