Job Details: Medical Review Spec I (Job Family) - 33931SY

Company: Wellpoint – WellPoint, Inc. was formed when WellPoint Health Networks, Inc. and Anthem, Inc. merged in 2004 to become the nation’s leading health benefits company. WellPoint, Inc. is the largest health benefits company in terms of commercial membership in the United States.

Description: Anthem Blue Cross is a proud member of the WellPoint family of companies and is one of California's oldest and largest health insurers.
At Anthem, we are dedicated to our mission of improving the health of the people we serve through improved health of Californians and improved access to care. We believe the best health care coverage can actually help people stay healthy.

Bring your expertise to our innovative, performance-focused culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.

This is an entry level Medical Review position, but may be filled at any level based on experience.

Reviews and analyzes institutional and professional claims and supporting medical documents to determine medical necessity of billed services and benefits payable according to established guidelines. Primary duties include, but are not limited to: Reviews, analyzes and renders determinations on requests from the providers and beneficiaries for reconsideration of previously rendered medical decisions relating to claims issues.

2 years of college or the equivalent and a minimum of 4 years health care experience or any combination of education and experience, which would provide an equivalent background required. Current unrestricted California RN or LVN license is required.

WellPoint is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2008 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at http://www.wellpoint.com
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