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Anthem, Inc. Mgr II Medicaid State Ops in Melville, New York

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.

This position will allow remote work until Anthem is cleared to return to the office (TBD) post COVID this position will report to any Anthem office as people leader role (Columbia, SC office preferred)

Responsible for health plan operations policies, dashboards, best practices and regulatory compliance. Identifies and prioritizes health plan opportunities for improvement in the areas of efficiency and effectiveness.

Primary duties may include, but are not limited to:

Partners and supports leadership across the health plan on assigned projects. Routinely liaises with Health Plan leadership, State Agencies and Alliance partners.

Participates in operational process improvement initiatives and facilitates collaborative effort between Health Plan and Corporate operations for implementation.

Serves as primary contact to Health Plan leaders to ensure appropriate key operational indicators are in place for monitoring and analysis.

Resolves operational issues to include enrollment, IT, benefit configuration, call metrics, authorizations, high dollar claims, pended claims, appeals, adjustments, customer service and policy issues.

Assists Health Plan Provider Relations with contracting process and resolution of provider reimbursement issues.

Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Qualifications

BA/BS in Business

7 years of related experience

Including 3 years of management experience (your assigned direct reports not PM leadership)

And 2 years of experience in data assimilation

Or any combination of education and experience, which would provide an equivalent background

Masters degree preferred

Claims processing or provider reimbursement configuration

Project Management (PMP) preferred

And WGS experience are preferred

Excellent communication skills and success at building/leading cross-functional, collaborative teams

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

REQNUMBER: PS39134

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