Your Talent. Our Vision. At Anthem Blue Cross and Blue Shield, 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.
Performance Quality Analyst II- Remote within 50 miles of Anthem office locations:
Indianapolis-IN, Denver-CO, Midland-GA, Richmond-VA, Norfolk/Virginia Beach-VA, Tampa-FL, Mason-OH, Fond du Lac-WI, Middletown-NY, or South Portland, ME
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 enrollment and billing and claims processing, reviewing and interpreting provider contracts and pricing, as well as customer service written and verbal inquiries. Primary duties may include, but are not limited to:
Assists higher level auditor/lead on field work as assigned and acts as auditor in charge on small and less complex audits.
Participates in pre and post implementation audits of providers, provider contracts and pricing, claims processing and payment, benefit coding, member and provider inquiries, enrollment & billing transactions, and the corrective action plan process.
Demonstrates ability to audit multiple lines of business, multiple functions, and multiple systems.
Analyzes and interprets data and makes recommendations for change based on judgment and experience, applies audit policy, and assesses risks to minimize our exposure and mitigate those risks.
Works 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with the business to provide consultation and advice to management related to policy and procedure identified as out of date or incomplete and investigates, develops and recommends process improvements and solutions.
Functions as a subject matter expert for discrepancy review, questions from team and business partners, and interpretation of guidelines and audit process.
Acts as a mentor to peer auditors, providing training and managing work and projects as necessary.
3+ years related experience in an enrollment and billing, claims and/or customer contact automated environment (preferably in healthcare or insurance sector), including a minimum of 1 year related experience in a quality audit capacity
or any combination of education and experience, which would provide an equivalent background.
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.