SHIFT: Day Job
Your Talent. Our Vision. At AIM Specialty Health (AIM), a proud member of the Anthem, Inc. family of companies, 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.
Top candidates for this position will ensure targets are met and AIM's company strategy is achieved through consistent development and coaching of their team. Through planning, coordination and management of team activities, maintain and enhance the customer experience and meet organizational and operational objectives.
This position is office-based and will be located in one of the following AIM offices: Deerfield or Westchester, IL OR Glendale, CA.
Primary duties may include, but are not limited to:
Provides management, organization, and coordination of day to day work;
Creates a positive work environment for the team through motivation, coaching and associate development;
Functions as a Subject Matter Expert for various client plans and AIM products;
Investigates customer's complaints and determines resolution;
Provides statistical and performance feedback and coaching on a regular basis;
Hires, trains, coaches, counsels, and evaluates performance of direct reports;
Addresses disciplinary and/or performance problems according to company policy;
Assists with the operation of the call center to include the development, analysis and implementation of staffing, training, scheduling, reward and recognition programs;
Ensures new processes and procedures are implemented and used effectively by the team while being a positive change agent;
Ensures a high level of knowledge within the Teams as evidenced through turnaround time of issues and ability to resolve issues independently;
Analyzes team, department, and product-line data to develop and implement action plans for improvement;
Acts as liaison with Customer Account Managers to ensure customer objectives are being met and complaints are resolved;
Collaborates with all levels of operations including physician, nurse, and non-clinical teams to ensure objectives are being met;
Administers company policies and procedures with little or no guidance;
Monitors Clinical Operations Nurse Reviewer call center metrics to assure compliance with AIM performance standards;
Assists in the monitoring of regulatory and health plan timeline compliance regarding denials and appeals;
Conducts clinical reviews with application of Medical Policy and Guidelines as required;
Attends departmental and other meetings, as required;
Other duties, as assigned.
Requires current unrestricted nursing license in CA or IL;
5 years acute care clinical experience, or any combination of education and experience, which would provide an equivalent background.
Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Ability to lead peers in projects, workload share and identify resources needed to successfully plan initiative or project required.
Good numeracy skills with the ability to analyze and interpret KPIs and how to use them to improve performance required.
Demonstrated ability to communicate and manage change within a team, explain reasons for change and secure team acceptance of change required.
BA/BS degree preferred.
Knowledge of AIM Specialty Health products and procedures preferred.
Knowledge of AIM Solution(s)preferred
Call Center experience preferred.
Management experience preferred.
On-site presence required once the company goes back to standard operations.
We are looking for coverage for the later shift. Expected hours to cover will be from 9:30 am -6:00 pm local time.
Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.