Additional Information
Anticipated End Date:
2026-06-22
Position Title:
Medical Review Analyst II
Job Description:
Medical Review Analyst II
Location : Any Elevance Health PulsePoint. Ideal candidate will reside within commutable distance to Norfolk, VA; Costa Mesa, CA; or Grand Prairie, TX.
Virtual : 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.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.
This position works standard working hours: 8am to 5pm, but not earlier than 8am EST.
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.
How you will make an impact:
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.
Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information.
Retrieval of physical copies of facility documents delivered to the Elevance Health facility.
Minimum 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.
Preferred Skills, Capabilities and Experiences:
Associate Degree preferred.
Understanding of provider networks, the medical record management processes, internal business processes, and proficiency with internal local technology preferred.
For candidates working in person or virtually in the below locations, the salary* range for this specific position is $22.50/hr to $40.51/hr
Location: California
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, non-discriminatory 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 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.
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.
Elevance Health (anthem) · Norfolk, 5800 Northampton Blvd, VA