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.
Must be located onsite in an IngenioRx core location: Atlanta, St. Louis, Virginia Beach, Morristown, Mason, Las Vegas, Wallingford, Louisville, Chicago, or Minneapolis.
Responsible for directing foundational and strategic compliance responsibilities with consistent excellence that support the team and management.
Primary duties with expert skill level and tasks with the most advanced complexity and broad/enterprise scale may include, but are not limited to:
Directs projects, initiatives, regulatory sanctions, executive-sponsored initiatives, regulatory audits or exams, internal audits, accreditations, on-site reviews, risk assessments; audit planning, conducting mock audits, conducting audit training, managing audit evidence preparation, assessing audit preparedness.
Leads compliance monitoring to identify process gaps, validate compliance levels, map processes, draft corrective actions/remediation plans, oversee implementation of corrective actions, prepare reports/presentations.
Leads complex investigations and documents findings.
Develops strategic plans, makes recommendations to leadership; designs/implements annual compliance plan.
Develop strong relationships with key leaders to identify and address compliance risks and failures and manage action plans designed to fully mitigate risk(s).
BA/BS; 8-10 years of health care, regulatory, ethics, compliance or privacy experience
Or any combination of education and experience, which would provide an equivalent background, including strong leadership/managerial skills and ability to motivate/coach other staff.
Minimal travel may be required.
Must be able to sit onsite in an IngenioRx office
Proficient in Microsoft Office
Knowledge of Medicare Advantage and Part D regulations
Keen verbal and written communication skills
Critical thinking and analytic skills
Ability to apply government regulations and translate those to business requirements
MS/MBA/JD or professional designation preferred;
Organizational Determinations, Clinical Programs, and other operations/performance areas
Medicaid Compliance regulations
Pharmacy Benefit Manager (PBM) experience
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.