Medical Review Analyst Senior

Anticipated End Date:

2025-09-17

Position Title:

Medical Review Analyst Senior

Job Description:

Medical Review Analyst Senior

Location: This role enables associates to work virtually full-time, with the exception of 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.

Please note that per our policy on virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. ​

The Medical Review Analyst Senior will be responsible to provide non-clinical review and analysis of all 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 complex Tier I requests.
• Serves as a liaison between medical management and/or service operations and other internal departments.
• Functions as an internal resource Subject Matter Expert (SME) for associates.
• Supports the department by independently participating in assigned projects and initiatives.
• Assists with the development of processes to support the MRA team.
• Responsibilities exclude conducting any utilization or medical management review activities which require interpretation of clinical information.

Minimum Requirements:

• Requires a HS Diploma or equivalent and a minimum of 7 years of claims processing or customer service experience managing complex claims, provider, or member issues; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

• Experience with medical coding and medical terminology.
• Knowledge of provider networks, the medical management process, internal business processes, and expertise with internal local technology.
• BS/BA preferred.

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $24.30 to $36.46.

Locations:  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 considered to be 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:

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.

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