Provider Payment Appeals Analyst I

Elevance Health

Provider payment appeals analyst resolving healthcare payment disputes for Elevance Health, a company simplifying healthcare. Reviewing claims, investigating decisions, and determining appropriate resolutions.

Posted 8/5/2026full-timeRemote • Virginia • 🇺🇸 United StatesMid-LevelSenior💰 $23 - $34 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in claims research, issue resolution, and reimbursement methodology analysis within the healthcare industry, with a strong focus on provider payment disputes and appeals. Proficient in reviewing and reprocessing claims to ensure appropriate resolutions.

Highest-signal resume keywords

Claims ResearchIssue ResolutionReimbursement Methodology AnalysisNextGenGBD Facets

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claims ResearchIssue ResolutionReimbursement Methodology AnalysisReviewing ClaimsReprocessing Claims

Tools & Technologies

NextGenGBD FacetsCCERT

Certifications & Qualifications

High School DiplomaGED

Industry Keywords

Healthcare IndustryPayment Dispute ProcessProvider Payment AppealProvider SolutionsHealth Plan Operations

About the role

Key responsibilities & impact

Support the Payment Dispute process across all lines of business
Resolve Provider Payment Appeal requests
Review and analyze provider requests to investigate dispute outcomes
Determine whether to uphold or overturn primary decisions based on all available information
Work with Provider Solutions and Health Plan Operations leadership to determine root causes and appropriate resolutions
Review and reprocess claims to provide appropriate solutions

Requirements

What you’ll need

High school diploma or GED
Minimum 3 years of claims research and/or issue resolution or reimbursement methodology analysis within the healthcare industry
Education and experience combination providing an equivalent background may be considered
Experience with NextGen, GBD Facets, and CCERT is highly preferred
Ability to work Monday–Friday, 8-hour shifts during EST
Ability to review and reprocess claims
Ability to work virtually full-time and attend required in-person training
Must be within a reasonable commuting distance from the posting location unless an accommodation is granted

Benefits

Comp & perks

Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401(k) contribution and match
Merit increases
Paid holidays
Paid Time Off
Incentive bonus programs
Medical benefits
Dental benefits
Vision benefits
Short- and long-term disability benefits
Stock purchase plan
Life insurance
Wellness programs
Financial education resources
Flexible start time between 6:00 am and 9:30 am EST
Required in-person training sessions with virtual full-time work otherwise