Medical Policy Analyst Sr (United States)

Anthem, Inc. New Haven , CT 06501

Posted 4 weeks 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 benefits companies and a Fortune Top 50 Company.

Location: United States and must live within one (1) hour of an Anthem office.

The Medical Policy Analyst, Sr. is responsible for researching, drafting, and maintaining Corporate medical polices and clinical UM guidelines ensuring the use of valid and consistent research methodologies and the creation of documents aligning with the most rigorous scientific evidence.

Primary duties may include, but are not limited to:

  • Conducting structured research of the peer-reviewed literature and other resources within defined methodologies using consistent templates, tools, and criteria to support:

  • Evaluation and assessment of potential new topics for development into Anthem's medical policy and clinical UM guidelines

  • Maintenance of existing medical policies clinical UM guidelines

  • Reviewing new and updated codes for appropriate application within the policy and guideline framework

  • Working with key stakeholder to assess Enterprise need for new and revised medical policies and clinical UM guidelines on new and evolving topics

  • Collaborating across Enterprise-wide workgroups and business units to facilitate proper implementation of medical policies and clinical UM guidelines

  • Responding to internal and external inquiries that warrant written clarification of a general or specific questions regarding medical policy and clinical UM guideline issues

  • Coordination and collaboration with Anthem subsidiaries on issues of mutual interest related to medical policy and clinical UM guideline topics



  • Requires a BA/BS in a related field (Biology, Chemistry, Nursing, etc.) or a RN (having an Associate's Degree or higher)

  • 5 years of related experience in Research in a science related field.; or any combination of education and experience, which would provide an equivalent background (i.e. Clinical Research, Medical Policy Research, basic science research, Public Health)

  • Clinical or medical policy research experience is required

  • Working knowledge of medical coding required

  • Nursing degree, MPH, or equivalent preferred

  • Experience and familiarity with genetics and genetic testing desired

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

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
Sr Financial Analyst

Yale University

Posted 1 week ago

VIEW JOBS 10/11/2020 12:00:00 AM 2021-01-09T00:00 Essential Duties 1. Financial modeling and forecasting: Provides specialized technical analysis to determine present and future financial performance. Organizes information from a variety of sources to establish data banks for use in analyzing and creating future plans and forecasts. Guides and collaborates with all levels of management, both internally and externally, to gather, analyze, summarize, prepare, and present recommendations regarding financial plans, trended future requirements, operating forecasts and/or similar complex financial matters. Researches and evaluates information to resolve issues and/or influence decisions. Conceptualizes, develops and executes multi-variable complex financial models. 2. Financial Analysis and Reporting: Analyzes and synthesizes information and designs and creates accurate and timely reports. Designs financial reporting to meet the compliance needs of internal and external users. Extracts and consolidates data from multiple sources. 3. Financial methods and systems: Influences, plans, and designs methods to improve practices, processes and systems. Leads and partners with all levels of internal and external contacts to execute departmental and/or institutional level goals. Provides a high level of service that cultivates and maintains strong working relationships and effectively communicates information; takes ownership and accountability for timeliness, accuracy and relationship management. 4. Strategic Resource: Translates department finance strategies into goals. Anticipates, identifies, and raises potential financial opportunities, issues, risks, ideas and solutions. Employs judgment and expertise in identifying the appropriate stakeholders to include in consultations, communications, approvals or buy-ins for designing and implementing changes. 5. Compliance and risk management: Establishes, implements and/or maintains strong internal controls in areas of assigned responsibility to provide reasonable assurance of effective and appropriate resources use, accurate financial information, and adherence to contractual obligations and agreements, policies, procedures, and external regulatory requirements. 6. Mentors, leads and/or supervises staff. 7. May perform other duties as assigned. Required Education and Experience Bachelor's degree in Accounting, Business, Economics or Finance and six years of related experience or an equivalent combination of education and experience. Demonstrated application of financial, accounting and economic concepts. Background Check Requirements All candidates for employment will be subject to pre-employment background screening for this position, which may include motor vehicle, DOT certification, drug testing and credit checks based on the position description and job requirements. All offers are contingent upon the successful completion of the background check. Please visit for additional information on the background check requirements and process. Position Focus: Primary responsibilities include monthly management of FFATA reporting of subawards, performance of desk audits for external subaward entities, manage data collection and reporting for required subrecipient monitoring activities, serve as audit liaison for outgoing subawards. Preferred Education, Experience and Skills: Financial management of federal subawards. Posting Disclaimer The intent of this job description is to provide a representative summary of the essential functions that will be required of the position and should not be construed as a declaration of specific duties and responsibilities of the particular position. Employees will be assigned specific job-related duties through their hiring departments. Affirmative Action Statement: Yale University considers applicants for employment without regard to, and does not discriminate on the basis of, an individual's sex, race, color, religion, age, disability, status as a veteran, or national or ethnic origin; nor does Yale discriminate on the basis of sexual orientation or gender identity or expression. Title IX of the Education Amendments of 1972 protects people from sex discrimination in educational programs and activities at institutions that receive federal financial assistance. Questions regarding Title IX may be referred to the University's Title IX Coordinator, at, or to the U.S. Department of Education, Office for Civil Rights, 8th Floor, Five Post Office Square, Boston MA 02109-3921. Telephone: 617.289.0111, Fax: 617.289.0150, TDD: 800.877.8339, or Email: Yale University New Haven CT

Medical Policy Analyst Sr (United States)

Anthem, Inc.