Medical Policy Analyst Sr

Anthem, Inc. , CT

Posted 2 months ago



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 care companies and a Fortune Top 50 Company.

Location: Remote Based

The Medical Policy Analyst, Sr is primarily responsible for developing new and maintaining existing corporate medical policies and clinical utilization management (UM) guidelines.

Primary duties may include, but are not limited to:

  • Conduction of literature searches and evaluation of scientific articles using epidemiological methods to assess quality and utility of new and existing technologies, treatments, and, procedures

  • Writing new or revising medical policies and clinical UM guidelines using standard templates, tools, and criteria

  • Review of new and updated codes for applicability to new and existing policy or guideline documents.

  • Survey of competitor and other payor positions

  • Identification and evaluation of relevant authoritative organizations' recommendations for inclusion in development process.

  • Responding to internal and external inquiries related to medical policy issues.

  • Reviewing and customization of MCG guidelines.


Minimum Requirements:

  • Requires at least a BA/BS degree in a scientific or clinical field and a minimum of 5 years related experience; or any combination of education and experience which would provide an equivalent background

  • Working knowledge of coding

  • Experience with policy, clinical, or basic science research experience.

  • Limited travel may be required

Preferred Qualifications:

  • Nursing degree or MPH preferred

  • Active state RN license preferred

  • Familiarity with epidemiological principles and applications preferred

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.

Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For, is ranked as one of the 2020 World's Most Admired Companies among health insurers by Fortune magazine, and a 2020 America's Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Technical Analyst Sr

Munich Re

Posted 3 days ago

VIEW JOBS 10/23/2021 12:00:00 AM 2022-01-21T00:00 Technical Analyst Sr WE OFFER The Technical Analyst Sr is a noncredentialled position in an actuarial department focusing on the deployment of rates and actuarial forecasting to HSB's clients both internal and external to the business. This includes but is not limited to client rate calculators, binding authority measurement, semi-automatic rate indications, model scoring logic and measurement of performance versus benchmarks. Build new such tools efficiently and accurately, as well as maintain and upgrade existing tools in current state. Knowledge of technical systems and able to co-design and advance strategic upgrades to platforms, methods and systems that result in a more sustainable ecosystem for rate and model deployment to internal and external clients. WE EXPECT Education & Experience: * Bachelors degree in a STEM or related field * 5+ years of insurance experience in an actuarial or adjacent technical position involving rating or the programming of complex rating algorithms or automating actuarial forecasts * Technical skills: * MS Office Suite to include knowledge of VBA * Demonstrated proficiency in reporting from relational data structures using SQL * Demonstrated Proficency in reporting software such as Power BI, Tableau, Qlikview * Experience in use of Python, SAS, or R for insurance pricing applications Knowledge & Skills: * Some knowledge of actuarial work such as pricing, reserving, rate filing, financial reporting * Knowledge of primary and non-traditional reinsurance/alternative market * Excellent computer skills. Strong programming skills preferred * Attention to detail * Effective time management skills * Self-driving and proactive * Work well both independently and in cross-disciplinary teams * Excellent oral and written communication skills * Excellent negotiation and conflict resolution skills * Strong interpersonal skills * Entrepreneurial spirit * Enjoy working in an environment where change is the only constant At The Hartford Steam Boiler, a subsidiary of Munich Re, we see Diversity and Inclusion as a solution to the challenges and opportunities all around us. Our goal is to foster an inclusive culture and build a workforce that reflects the customers we serve and the communities in which we live and work. We strive to provide a workplace where all of our colleagues feel respected, valued and empowered to achieve their very best every day. We recruit and develop talent with a focus on providing our customers the most innovative products and services. We are an equal opportunity employer. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The Hartford Steam Boiler Inspection and Insurance Company (HSB), a part of Munich Re since 2009, provides equipment breakdown and other specialty coverages, inspection services and engineering consulting that set the standard for excellence worldwide. One of the world's leading equipment breakdown insurers, HSB helps clients reduce risk through a unique combination of specialty coverages, engineering-based risk management strategies and loss prevention services. A.M. Best Company awarded the HSB Group of companies its highest financial rating, A++ (Superior). We look ahead, anticipate risk and leverage our knowledge and experience to develop new solutions to help our clients meet tomorrow's challenges. To see the future we see check out our LinkedIn page: Munich Re Hartford CT

Medical Policy Analyst Sr

Anthem, Inc.