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Description SHIFT: Day JobSCHEDULE: Full-timeLocation – Remote Nationwide Be part of an extraordinary team We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact? Responsible for driving service quality excellence by evaluating the quality of services and interactions provided by organizations within the enterprise. Included are processes related to provider and pricing configuration and respective downstream processes, as well as provider inquiries Essential Duties and Responsibilities Primary duties may include, but are not limited to: Acts as auditor in charge for audits and special projects, producing engagement planning and testing strategies.
Translates business need into appropriate, comprehensive quality validation strategies and design.
Participates in audits of provider configuration.
Audits multiple lines of business, multiple functions, and multiple systems.
Trend audit results and perform data analysis on trends to determine/recommend adjustments to quality reviews.
Work closely with the business to provide consultation and advice to management related to policy and procedure identified as out of date or incomplete and investigates, develops and recommends process improvements and solutions.
Manage process improvement process; May include activities such leading workgroups, facilitating SWAT sessions, drafting new workflow or procedures.
Functions as a subject matter expert for discrepancy review, questions from team and business partners, and interpretation of guidelines and audit process.
Facilitate and lead meetings with business to review audit plan, audit findings and/or recommendations for improvement.
Acts as a mentor to peer auditors, providing training and managing work and projects as necessary.
Facilitate calibration sessions with the business area, support areas, vendors or clients.
Qualifications Requires a BS/BA; 4-5+ years related experience in provider or pricing configuration or any combination of education and experience, which would provide an equivalent background
Preferred Qualifications:
Advanced Excel and Access Capabilities
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.
Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.
REQNUMBER: PS72593-Georgia
Vacancy expired!