Company Detail

Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

CareMore Care Management Manager I Location: Position will work primarily from home, with occasional travel to CareMore clinics.

Be part of an extraordinary team We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Build the Possibilities. Make an extraordinary impact. CareMore is a proud member of the Anthem family of brands, offering clinical programs and primary care options for seniors. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery.

We are hiring a Manager I - Care More Care Management. Responsible for managing the implementation of clinical protocols and programs. How you will make an impact:

• Manages quality improvement, resource management, cost containment, case management, and member and provider grievance resolution.

• Assists in managing department policies and procedures, clinical data analysis, ancillary contract implementation, and provider education.

• Assists in creating annual Case Management (CM) work plan, quarterly reports, and annual evaluations.

• Manages the implementation of CM programs and monitors and recommends modifications.

• Represents the Health Plan in vendor meetings.

• Attends meetings and medical management committees.

• Collaborates with local physicians to provide support for positive member outcomes.

• Evaluates CM system/clinical operation effectiveness and presents findings to management.

• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Qualifications

Minimum Requirements:

• Requires an RN and minimum of 4 years of experience; or any combination of education and experience, which would provide an equivalent background.

• 1-2 years of case management experience.

• Current unrestricted RN license in CA required.

• For CareMore business units, satisfactory completion of a Tuberculosis test is a requirement for this position.

Preferred Qualifications:

• BS in Nursing preferred.

• Leadership experience preferred.

• Case management certification 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. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

REQNUMBER: PS73346

Job Detail

• Company:
  Anthem, Inc.

Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

Sign-On Bonus: To be offered to selected candidate

Job Title: Remote Nurse Appeals Location: Remote/Work From Home (Considering candidates who are within 1-hour drive of an Anthem (Pulse Point) location and be able to commute to the office if necessary).*

*Selected candidate must ensure work at home office is in a dedicated private and secure room adhering to HIPPA compliance regulations.

Business Hours: 8:00am-8:00pm Est. Shift Hours: 8-hour shift /40-hour workweek within business hours indicated, including holidays and weekends on a rotational basis.**

**This is not a flex hour role. Desired hours must be discussed with Hiring Manager.

Training/Orientation Schedule: Mon-Friday (8:00am-5:00pm Est.) - about 3-4 months.

Be part of an extraordinary team! We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

How you will make an impact: The Nurse Appeals role is responsible for investigating and processing medical necessity appeals requests from members and providers.

Primary duties may include, but are not limited to:

• Conducts investigations and reviews of member and provider medical necessity appeals.

• Reviews prospective, inpatient, or retrospective medical records of denied services for medical necessity.

• Extrapolates and summarizes medical information for medical directors, consultants, and other external reviews.

• Prepares recommendations to either uphold or deny appeal and forwards to Medical Director for approval.

• Ensures that appeals and grievances are resolved timely to meet regulatory timeframes.

• Documents and logs appeal/grievance information on relevant tracking systems and mainframe systems.

• Generates written correspondence to providers, members, and regulatory entities.

• Utilizes leadership skills and serves as a subject matter expert for appeals/grievances/quality of care issues and is a resource for clinical and non-clinical team members in expediting the resolution of outstanding issues.

Qualifications

Minimum Requirements:

• Requires a minimum of 2 years of experience in a managed care healthcare setting; or any combination of education and experience, which would provide an equivalent background.

• Current active unrestricted RN license to practice as a health professional within the scope of licensure in residing state or territory of the United States required.

Preferred Skills, Capabilities and Experiences:

• AS or BS in Nursing preferred.

• Case management, or Nurse Appeals experience is highly desirable =.

• Medicaid or Medicaid experience highly desirable.

• Skilled Nursing / Long term care is preferred

• Previous experience in insurance is highly desirable.

For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

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.

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.

Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

REQNUMBER: PS74172-Virginia

Job Detail

• Company:
  Anthem, Inc.

Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

Approver Sr. Dearborn, MI 48120

Be part of an extraordinary team. We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

The Disability Care Coordinator/Senior Approver (Union Role) -DCC is responsible for the management of Disability claims for group policy holders to include investigation, documentation, and authorization of payment. The DCC also pays claims and completes minor adjustments. There is constant interaction with claimants, medical professionals, and other vendors. DCC will handle statutory, occupational, and non-occupational claims as well as claims that fall outside duration guidelines.

Duties and Responsibilities:

• Responsible for adjudicating all STD claims in a timely manner

• Manage claims in accordance with company standards, which includes the Statement of Work and Client Contract Plan Language

• Providing excellent customer service

• Gather clinical and confirm eligibility information to verify approved period of disability

• Maintain awareness of the ERISA, Fair Claims Practices Model Act, privacy regulations, and state-mandated laws, and abides by them as dictated by each individual claim

• Actively enlist the services of support services (Physician Advisor, Vocational Rehabilitation, etc.) to assist with claim management

• Ability to interact with treating sources to negotiate appropriate treatment plan and return to works

• Responsible for timely and accurate payment of Disability claims

• Ability to determine and withhold FICA, Federal and State Levies

• Determine and calculate appropriate offsets

• Correspond via letter and telephone with employee, physicians, employers, hospitals, rehabilitation, and other vendors to obtain claim information

• Is responsible for mailing appropriate state program forms as well as required company disability forms to the employee

• General claims support duties to include telephone coverage

• Other duties as assigned

Qualifications

• High School Diploma

• Preferred: BA and/or equivalent work experience

• Comprehensive knowledge of group insurance principles and practices

• Proficient contractual understanding of group Disability product

• Basic computing and keyboarding skills required with proficiency in Word and Excel

• Excellent oral and written communication skills including active listening

• Ability to make timely and effective decisions

• Ability to work independently as well as working effectively in a team environment

  Knowledge/Experience:

• Provides superior, professional, and courteous service to our customers

• Provides timely and accurate resolution of inquiries and issues regarding claim payment regarding benefits, policies, and contracts

• Handles complex calls and situations by taking ownership of issues to ensure timely resolution or follow-up

• Conducts research and resolves issues

• Participates in specials projects assigned

• Demonstrates full competence in own work area

• Makes significant contribution to work team

• Performs other duties as assigned

  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.

  The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state, and local laws.

  Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

  REQNUMBER: PS74351-US

Job Detail

• Company:
  Anthem, Inc.

Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

Approver Sr. Dearborn, MI 48120

Be part of an extraordinary team. We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

The Disability Care Coordinator/Senior Approver (Union Role) -DCC is responsible for the management of Disability claims for group policy holders to include investigation, documentation, and authorization of payment. The DCC also pays claims and completes minor adjustments. There is constant interaction with claimants, medical professionals, and other vendors. DCC will handle statutory, occupational, and non-occupational claims as well as claims that fall outside duration guidelines.

Duties and Responsibilities:

• Responsible for adjudicating all STD claims in a timely manner

• Manage claims in accordance with company standards, which includes the Statement of Work and Client Contract Plan Language

• Providing excellent customer service

• Gather clinical and confirm eligibility information to verify approved period of disability

• Maintain awareness of the ERISA, Fair Claims Practices Model Act, privacy regulations, and state-mandated laws, and abides by them as dictated by each individual claim

• Actively enlist the services of support services (Physician Advisor, Vocational Rehabilitation, etc.) to assist with claim management

• Ability to interact with treating sources to negotiate appropriate treatment plan and return to works

• Responsible for timely and accurate payment of Disability claims

• Ability to determine and withhold FICA, Federal and State Levies

• Determine and calculate appropriate offsets

• Correspond via letter and telephone with employee, physicians, employers, hospitals, rehabilitation, and other vendors to obtain claim information

• Is responsible for mailing appropriate state program forms as well as required company disability forms to the employee

• General claims support duties to include telephone coverage

• Other duties as assigned

Qualifications

• High School Diploma

• Preferred: BA and/or equivalent work experience

• Comprehensive knowledge of group insurance principles and practices

• Proficient contractual understanding of group Disability product

• Basic computing and keyboarding skills required with proficiency in Word and Excel

• Excellent oral and written communication skills including active listening

• Ability to make timely and effective decisions

• Ability to work independently as well as working effectively in a team environment

  Knowledge/Experience:

• Provides superior, professional, and courteous service to our customers

• Provides timely and accurate resolution of inquiries and issues regarding claim payment regarding benefits, policies, and contracts

• Handles complex calls and situations by taking ownership of issues to ensure timely resolution or follow-up

• Conducts research and resolves issues

• Participates in specials projects assigned

• Demonstrates full competence in own work area

• Makes significant contribution to work team

• Performs other duties as assigned

  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.

  The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state, and local laws.

  Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

  REQNUMBER: PS74351-US

Job Detail

• Company:
  Anthem, Inc.

Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

Be part of an extraordinary team.

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change.

Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

The Systems Analyst Sr Advisor is responsible for defining and managing the scope of Business Systems projects.

Primary duties may include, but are not limited to:

• Defines functional, usability, reliability, performance and support requirements of a system.

• Creates and performs feature testing and determines environmental needs.

• Provides the link between the technical and business views of the system by ensuring that the technical solutions being developed will satisfy the needs of the business.

• Partners with business, architecture and infrastructure and oversees all service levels to ensure business area satisfaction. In depth knowledge of tools utilized.

• Defines detail design components with high level architecture blueprints.

• Coordinates integration activities to ensure successful implementation.

• Ensures effective monitoring of systems.

• Defines development strategy, standards and support tools.

• Proactively works with stakeholders to identify future system opportunities and enhancements.

Qualifications

Minimum Requirements:

• Requires an BA/BS degree in Information Technology, Computer Science or related field of study and a minimum of 8 years experience in a variety of technologies, documenting requirements and/or building test cases; or any combination of education and experience, which would provide an equivalent background. Business Analyst or Business Systems Analyst certifications strongly preferred.

Preferred Qualifications:

• Experience with mainframe computer, hardware and operating systems and the impacts of changes in the systems stream, testing/product quality processes, tools and methods strongly preferred.

• Experience with Rational tools, Six Sigma or other process improvement training strongly 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. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

  REQNUMBER: PS73722

Job Detail

• Company:
  Anthem, Inc.

Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

Approver Sr. Dearborn, MI 48120

Be part of an extraordinary team. We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

The Disability Care Coordinator/Senior Approver (Union Role) -DCC is responsible for the management of Disability claims for group policy holders to include investigation, documentation, and authorization of payment. The DCC also pays claims and completes minor adjustments. There is constant interaction with claimants, medical professionals, and other vendors. DCC will handle statutory, occupational, and non-occupational claims as well as claims that fall outside duration guidelines.

Duties and Responsibilities:

• Responsible for adjudicating all STD claims in a timely manner

• Manage claims in accordance with company standards, which includes the Statement of Work and Client Contract Plan Language

• Providing excellent customer service

• Gather clinical and confirm eligibility information to verify approved period of disability

• Maintain awareness of the ERISA, Fair Claims Practices Model Act, privacy regulations, and state-mandated laws, and abides by them as dictated by each individual claim

• Actively enlist the services of support services (Physician Advisor, Vocational Rehabilitation, etc.) to assist with claim management

• Ability to interact with treating sources to negotiate appropriate treatment plan and return to works

• Responsible for timely and accurate payment of Disability claims

• Ability to determine and withhold FICA, Federal and State Levies

• Determine and calculate appropriate offsets

• Correspond via letter and telephone with employee, physicians, employers, hospitals, rehabilitation, and other vendors to obtain claim information

• Is responsible for mailing appropriate state program forms as well as required company disability forms to the employee

• General claims support duties to include telephone coverage

• Other duties as assigned

Qualifications

• High School Diploma

• Preferred: BA and/or equivalent work experience

• Comprehensive knowledge of group insurance principles and practices

• Proficient contractual understanding of group Disability product

• Basic computing and keyboarding skills required with proficiency in Word and Excel

• Excellent oral and written communication skills including active listening

• Ability to make timely and effective decisions

• Ability to work independently as well as working effectively in a team environment

  Knowledge/Experience:

• Provides superior, professional, and courteous service to our customers

• Provides timely and accurate resolution of inquiries and issues regarding claim payment regarding benefits, policies, and contracts

• Handles complex calls and situations by taking ownership of issues to ensure timely resolution or follow-up

• Conducts research and resolves issues

• Participates in specials projects assigned

• Demonstrates full competence in own work area

• Makes significant contribution to work team

• Performs other duties as assigned

  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.

  The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state, and local laws.

  Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

  REQNUMBER: PS74351-US

Job Detail

• Company:
  Anthem, Inc.

Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

Be part of an extraordinary team.

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change.

Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

The Systems Analyst Sr Advisor is responsible for defining and managing the scope of Business Systems projects.

Primary duties may include, but are not limited to:

• Defines functional, usability, reliability, performance and support requirements of a system.

• Creates and performs feature testing and determines environmental needs.

• Provides the link between the technical and business views of the system by ensuring that the technical solutions being developed will satisfy the needs of the business.

• Partners with business, architecture and infrastructure and oversees all service levels to ensure business area satisfaction. In depth knowledge of tools utilized.

• Defines detail design components with high level architecture blueprints.

• Coordinates integration activities to ensure successful implementation.

• Ensures effective monitoring of systems.

• Defines development strategy, standards and support tools.

• Proactively works with stakeholders to identify future system opportunities and enhancements.

Qualifications

Minimum Requirements:

• Requires an BA/BS degree in Information Technology, Computer Science or related field of study and a minimum of 8 years experience in a variety of technologies, documenting requirements and/or building test cases; or any combination of education and experience, which would provide an equivalent background. Business Analyst or Business Systems Analyst certifications strongly preferred.

Preferred Qualifications:

• Experience with mainframe computer, hardware and operating systems and the impacts of changes in the systems stream, testing/product quality processes, tools and methods strongly preferred.

• Experience with Rational tools, Six Sigma or other process improvement training strongly 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. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

  REQNUMBER: PS73722

Job Detail

• Company:
  Anthem, Inc.

Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

Approver Sr. Dearborn, MI 48120

Be part of an extraordinary team. We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

The Disability Care Coordinator/Senior Approver (Union Role) -DCC is responsible for the management of Disability claims for group policy holders to include investigation, documentation, and authorization of payment. The DCC also pays claims and completes minor adjustments. There is constant interaction with claimants, medical professionals, and other vendors. DCC will handle statutory, occupational, and non-occupational claims as well as claims that fall outside duration guidelines.

Duties and Responsibilities:

• Responsible for adjudicating all STD claims in a timely manner

• Manage claims in accordance with company standards, which includes the Statement of Work and Client Contract Plan Language

• Providing excellent customer service

• Gather clinical and confirm eligibility information to verify approved period of disability

• Maintain awareness of the ERISA, Fair Claims Practices Model Act, privacy regulations, and state-mandated laws, and abides by them as dictated by each individual claim

• Actively enlist the services of support services (Physician Advisor, Vocational Rehabilitation, etc.) to assist with claim management

• Ability to interact with treating sources to negotiate appropriate treatment plan and return to works

• Responsible for timely and accurate payment of Disability claims

• Ability to determine and withhold FICA, Federal and State Levies

• Determine and calculate appropriate offsets

• Correspond via letter and telephone with employee, physicians, employers, hospitals, rehabilitation, and other vendors to obtain claim information

• Is responsible for mailing appropriate state program forms as well as required company disability forms to the employee

• General claims support duties to include telephone coverage

• Other duties as assigned

Qualifications

• High School Diploma

• Preferred: BA and/or equivalent work experience

• Comprehensive knowledge of group insurance principles and practices

• Proficient contractual understanding of group Disability product

• Basic computing and keyboarding skills required with proficiency in Word and Excel

• Excellent oral and written communication skills including active listening

• Ability to make timely and effective decisions

• Ability to work independently as well as working effectively in a team environment

  Knowledge/Experience:

• Provides superior, professional, and courteous service to our customers

• Provides timely and accurate resolution of inquiries and issues regarding claim payment regarding benefits, policies, and contracts

• Handles complex calls and situations by taking ownership of issues to ensure timely resolution or follow-up

• Conducts research and resolves issues

• Participates in specials projects assigned

• Demonstrates full competence in own work area

• Makes significant contribution to work team

• Performs other duties as assigned

  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.

  The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state, and local laws.

  Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

  REQNUMBER: PS74351-US

Job Detail

• Company:
  Anthem, Inc.

Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

Behavioral Health Medical Director - Remote in California Location: Remote, must live in CA.

Be part of an extraordinary team We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Behavioral Health Medical Director - California Responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most cost-effective medical care is received. This position will heavily focus on utilization review. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program.

How you will make an impact:

• Supports clinicians to ensure timely and consistent responses to members and providers.

• Provides guidance for clinical operational aspects of a program.

• Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with providers and external physicians.

• May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.

• Serves as a resource and consultant to other areas of the company.

• May be required to represent the company to external entities and/or serve on internal and/or external committees.

• May chair company committees. Interprets medical policies and clinical guidelines.

• May develop and propose new medical policies based on changes in healthcare.

• Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality cost and outcomes.

• Identifies and develops opportunities for innovation to increase effectiveness and quality.

Qualifications

Minimum Requirements:

• MD or DO

• Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Psychiatry and Neurology in Psychiatry.

• Must possess an active unrestricted medical license in the state of California.

• Must reside in California.

• Minimum of 5 years of experience providing health care is required.

Preferred Skills, Capabilities, and Experience:

• Utilization Review experience preferred.

• Addiction and/or Child and Adolescent Psychiatry Certification preferred.

• Ability to work collaboratively with a multi-disciplinary team required.

• Behavioral Health Addiction Psychiatry background 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. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

REQNUMBER: PS74286

Job Detail

• Company:
  Anthem, Inc.

Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

Approver Sr. Dearborn, MI 48120

Be part of an extraordinary team. We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

The Disability Care Coordinator/Senior Approver (Union Role) -DCC is responsible for the management of Disability claims for group policy holders to include investigation, documentation, and authorization of payment. The DCC also pays claims and completes minor adjustments. There is constant interaction with claimants, medical professionals, and other vendors. DCC will handle statutory, occupational, and non-occupational claims as well as claims that fall outside duration guidelines.

Duties and Responsibilities:

• Responsible for adjudicating all STD claims in a timely manner

• Manage claims in accordance with company standards, which includes the Statement of Work and Client Contract Plan Language

• Providing excellent customer service

• Gather clinical and confirm eligibility information to verify approved period of disability

• Maintain awareness of the ERISA, Fair Claims Practices Model Act, privacy regulations, and state-mandated laws, and abides by them as dictated by each individual claim

• Actively enlist the services of support services (Physician Advisor, Vocational Rehabilitation, etc.) to assist with claim management

• Ability to interact with treating sources to negotiate appropriate treatment plan and return to works

• Responsible for timely and accurate payment of Disability claims

• Ability to determine and withhold FICA, Federal and State Levies

• Determine and calculate appropriate offsets

• Correspond via letter and telephone with employee, physicians, employers, hospitals, rehabilitation, and other vendors to obtain claim information

• Is responsible for mailing appropriate state program forms as well as required company disability forms to the employee

• General claims support duties to include telephone coverage

• Other duties as assigned

Qualifications

• High School Diploma

• Preferred: BA and/or equivalent work experience

• Comprehensive knowledge of group insurance principles and practices

• Proficient contractual understanding of group Disability product

• Basic computing and keyboarding skills required with proficiency in Word and Excel

• Excellent oral and written communication skills including active listening

• Ability to make timely and effective decisions

• Ability to work independently as well as working effectively in a team environment

  Knowledge/Experience:

• Provides superior, professional, and courteous service to our customers

• Provides timely and accurate resolution of inquiries and issues regarding claim payment regarding benefits, policies, and contracts

• Handles complex calls and situations by taking ownership of issues to ensure timely resolution or follow-up

• Conducts research and resolves issues

• Participates in specials projects assigned

• Demonstrates full competence in own work area

• Makes significant contribution to work team

• Performs other duties as assigned

  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.

  The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state, and local laws.

  Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

  REQNUMBER: PS74351-US

Job Detail

• Company:
  Anthem, Inc.

Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

CareMore Care Management Manager I Location: Position will work primarily from home, with occasional travel to CareMore clinics.

Be part of an extraordinary team We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Build the Possibilities. Make an extraordinary impact. CareMore is a proud member of the Anthem family of brands, offering clinical programs and primary care options for seniors. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery.

We are hiring a Manager I - Care More Care Management. Responsible for managing the implementation of clinical protocols and programs. How you will make an impact:

• Manages quality improvement, resource management, cost containment, case management, and member and provider grievance resolution.

• Assists in managing department policies and procedures, clinical data analysis, ancillary contract implementation, and provider education.

• Assists in creating annual Case Management (CM) work plan, quarterly reports, and annual evaluations.

• Manages the implementation of CM programs and monitors and recommends modifications.

• Represents the Health Plan in vendor meetings.

• Attends meetings and medical management committees.

• Collaborates with local physicians to provide support for positive member outcomes.

• Evaluates CM system/clinical operation effectiveness and presents findings to management.

• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Qualifications

Minimum Requirements:

• Requires an RN and minimum of 4 years of experience; or any combination of education and experience, which would provide an equivalent background.

• 1-2 years of case management experience.

• Current unrestricted RN license in CA required.

• For CareMore business units, satisfactory completion of a Tuberculosis test is a requirement for this position.

Preferred Qualifications:

• BS in Nursing preferred.

• Leadership experience preferred.

• Case management certification 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. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

REQNUMBER: PS73346

Job Detail

• Company:
  Anthem, Inc.

Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

Behavioral Health Medical Director - Remote in California Location: Remote, must live in CA.

Be part of an extraordinary team We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Behavioral Health Medical Director - California Responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most cost-effective medical care is received. This position will heavily focus on utilization review. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program.

How you will make an impact:

• Supports clinicians to ensure timely and consistent responses to members and providers.

• Provides guidance for clinical operational aspects of a program.

• Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with providers and external physicians.

• May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.

• Serves as a resource and consultant to other areas of the company.

• May be required to represent the company to external entities and/or serve on internal and/or external committees.

• May chair company committees. Interprets medical policies and clinical guidelines.

• May develop and propose new medical policies based on changes in healthcare.

• Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality cost and outcomes.

• Identifies and develops opportunities for innovation to increase effectiveness and quality.

Qualifications

Minimum Requirements:

• MD or DO

• Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Psychiatry and Neurology in Psychiatry.

• Must possess an active unrestricted medical license in the state of California.

• Must reside in California.

• Minimum of 5 years of experience providing health care is required.

Preferred Skills, Capabilities, and Experience:

• Utilization Review experience preferred.

• Addiction and/or Child and Adolescent Psychiatry Certification preferred.

• Ability to work collaboratively with a multi-disciplinary team required.

• Behavioral Health Addiction Psychiatry background 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. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

REQNUMBER: PS74286

Job Detail

• Company:
  Anthem, Inc.

Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

Be part of an extraordinary team!

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change.

Do you want to be part of a larger purpose and an evolving high-performance culture that empowers you to make an impact?

Supports multiple operations departments by participating in project and process work.

Primary duties may include, but are not limited to: - Research operations workflow problems and system irregularities; develops, tests, presents process improvement solutions for new systems, new accounts and other operational improvements. - develops and leads project plans and communicates project status. - provides process direction and decision making for all minor and major project work. - provides guidance to process experts. - May perform duties as a lead when involved with enterprise-wide initiatives/projects. - Supports development, management and oversight of market audits, readiness, workflows, information requests, process improvement solutions for market issues. - Supports development and maintenance of administrative pharmacy policies and standard operating procedures in each market to ensure compliance with federal and state guidance and regulations. - Performs oversight of the process and outcomes of internal review of adverse determination pharmacy letters to ensure compliance with NCQA, URAC and Enterprise best practices.

Qualifications

- Requires a BA/BS - 5 - 8 years' experience in business analysis, process improvement, project coordination in a high-volume managed care operation (claims, customer service, enrollment and billing); or any combination of education and experience, which would provide an equivalent background. - Ability to analyze and design workflows, processes, supporting systems and procedures and identify improvements strongly preferred. - Ability to work on a high function team and respond appropriately to high priority situations - Ability to self-manage and prioritize multiple projects and priorities; and communicate openly and constructively regarding work on team meetings and with a supervisor.

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.

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.

Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

REQNUMBER: PS73801-Georgia

Job Detail

• Company:
  Anthem, Inc.

Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

Location - Remote Nationwide

Be part of an extraordinary team.

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving high-performance culture that empowers you to make an impact?

The Beacon Health Options (Beacon) Medicare Compliance Consultant Senior will work closely with the Beacon Medicare Compliance Officer to monitor compliance with Medicare Advantage and Medicare-Medicaid Plan requirements.

Consultant will advise internal business units on Medicare operational compliance, reporting and audits (CMS Program Audits (ODAG/SARAG) and Part C Data Validation).

Essential Duties and Responsibilities Primary duties may include, but are not limited to: - At the most senior advanced level, report, communicate, research laws, regulations, requirements, regulatory audits and/or exams. - Provide senior level analytical support to projects, initiatives, regulatory audits or client oversight audits, internal audits,on-site reviews and, risk assessments. - Utilize systems unique to job functions, including standard-issue software such as Microsoft products including SharePoint; maintain system documentation, serve as subject matter expert, train users of system, contribute to system design, oversight or maintenance. - Apply critical thinking to formulate strategies and concepts that drive results, persuade and influence others, adapt to change, and manage conflict.

Qualifications

- Requires a BA/BS and minimum of 5 years health care, regulatory, ethics, compliance or privacy experience; or any combination of education and experience, which would provide an equivalent background. - Ability to travel may be required.

Preferred Qualifications: - In-depth knowledge of Medicare health plan operations, reporting and audits including CMS Program Audits (ODAG/SARAG protocols) and Part C technical specifications. - A combination of appeals and grievances, claims, clinical, customer service, provider relations, and/or compliance functions in a Medicare Advantage /delegated Medicare Advantage environment required. - Preference will be given to candidates with certifications such as Certified in Healthcare Compliance (CHC)R or Certified Compliance & Ethics Professional (CCEP)R

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.

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.

Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

REQNUMBER: PS74267-California

Job Detail

• Company:
  Anthem, Inc.

Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

Job Title: UX Designer Senior

NOTE: Please include a link to your portfolio on your resume or cover letter.

Be part of an extraordinary team.

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Responsible for the navigation, organization and interaction design for leading-edge web solutions and applications. Applies user-centered design methods to translate user needs, business objectives and technology capabilities into best in class user experiences.

Primary duties may include, but are not limited to:

• Responsible for creating and maintaining the design system that all product design teams, engineers, and product managers use to design and develop products.

• Works with other designers, digital product managers and technology teams to create and implement best in class design solutions across our product lines.

• Use of visual design and problem-solving skills to deliver a cohesive and compelling UI Kit for a new generation of data-intensive, digital products used by healthcare professionals, practices, and patients.

• Designs web and mobile layouts, designs conversions across devices, and supports supplementary design requirements, like photo editing and preparing comps for presentations.

• Design visual language and UI components that are approachable and aesthetic

• Works with senior designers to produce style guidelines defining our products visual identity.

• Creates the best design production based on project needs that will help people understand complex data towards improving members health.

• Mentors and provides guidance to junior designers.

Qualifications

• Requires a BA/BS in a design discipline

• Minimum of 10 years experience, including minimum of 8 years leading and contributing to creative projects resulting in proven successful outcomes for users and the business.

• Or any combination of education and experience, which would provide an equivalent background.

• Agile certification preferred.

• Experience with designing UI components that adhere to ADA & WCAG accessibility requirements

  Preferred Skills:

• A track record that demonstrates exceptional visual design skills that show mastery in presenting complex visual information with awareness for information hierarchy, flow and context, including states and transitions.

• Strong rapid visualization skills for quickly generating, iterating, and visually pitching your ideas as concept sketches, storyboards, etc.

• The ability to work comfortably in a wide array of styles

• Flexibility in your ability to work at the appropriate level of visual fidelity (thumbnailing, sketching, wireframing, designing and polishing).

• Experience designing digital products for Health care

• Illustration skills, ability to create iconography that would be used in the UI Kit

• Experience in B2B environments, healthcare or other regulated sectors is a plus

  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.

  The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.

  Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

  REQNUMBER: PS73719

Job Detail

• Company:
  Anthem, Inc.

Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

Be part of an extraordinary team! We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving high-performance culture that empowers you to make an impact?

Job Description: Responsible for acting as a member of the Agile leadership team and is the functional and/or client (or business) representative for a project or set of projects within a market-focus.

Primary duties may include, but are not limited to: - Translating features into user stories within a teams backlog and managing ranking and prioritizing this backlog so that it is reflective of stakeholder requirements and priorities. - Final testing and acceptance of the user stories supporting the features. - Effectively communicate to the team the stakeholder needs so the teams delivery meets both contractual requirements and established acceptance criteria including expected quality and performance, and to complete various work management activities according to defined service level commitments and process compliancy guidelines. - Collaborate with team(s) to discover and deliver the best solution to the market problem(s) presented by the Product Manager (business). - Works with the business to understand, rank and prioritize business needs and plan solutions to ensure that each release provides business value to end users sales and marketing. - Manage the solution concept development process to ensure the product team understand the direction and vision. - Create and maintain regularly the solution vision roadmap and backlog of work through the project's life cycle. - Understands how to write user stories and their acceptance criteria. - Translates the product backlog into user stories. Serve as the Product Management (business) proxy and decision point to represent the stakeholders in the project. - Reviews and accepts/rejects results both during a Sprint and in the Sprint review. - Attends sprint ceremonies and is available to team during the sprint for clarifications and acceptance of user stories. - Creates and/or inputs into a projects release plan. - Presents work to team from Team Backlog during Sprint Planning for acceptance by the Team in a Sprint negotiates Sprint goals with the Team.

Qualifications

Minimum Qualifications: - Requires a BA/BS and minimum of 3 years' experience with writing business/functional requirements and experience implementing Agile methodologies; or any combination of education and experience, which would provide an equivalent background.

Preferred Qualifications: - Leading SAFe (SA) certification, CSPO or equivalent (Certified Scrum Product Owner) and/or SPO/PM (SAFE Product Owner/Product Manager) strongly 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.

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.

Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

REQNUMBER: PS73667-Virginia

Job Detail

• Company:
  Anthem, Inc.

Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

Be part of an extraordinary team:

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action, and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Network Data Specialist I, II, Sr Locations: GA, FL, NC, SC, PA, RI, MA, NY, NJ, NH (Fully Remote)

Build the Possibilities. Make an extraordinary impact:

The Network Data Specialist I is responsible for accurate and timely maintenance of provider information on claims and provider databases.

How you will make an Impact:

- Assists in synchronization of data among multiple claims systems and application of business rules as they apply to each database. - Validates the data to be housed on provider databases and ensuring adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing.

The Network Data Specialist II is responsible for accurate, timely maintenance of critical provider information on all claims and provider databases.

How you will make an Impact:

- Maintains critical provider information on all claims and provider databases. - Synchronizes data among multiple claims systems and application of business rules as they apply to each database. - Validates the data to be housed on provider databases and ensuring adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing.

The Network Data Specialist Sr is responsible for accurate, timely maintenance of complex provider information and synchronization of data on all claims and provider databases including expertise on business requirements for multiple business regions.

How you will make an Impact:

- Leads the department in problem identification, analysis, and resolution for multiple system provider database issues. - Participates in system testing and analysis in support of new functionality, new system processes, and business rules changes. - Validates the data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing. - Researches and resolves complex exceptions and error reports, determine regional/cap/business indicators for multiple business areas to assure accurate reimbursement based on provider contract and area fee schedules. - Determines training needs and train less experienced associates and outside customers on multiple provider data base systems and business requirements. - Audits for functional and business applications, and report accuracy standards.

Qualifications

Minimum Requirements: Requires a H.S. diploma; basic PC office software; or any combination of education and experience, which would provide an equivalent background.

Preferred Qualifications: 1-3 years' experience in claims processing, provider, or credentialing strongly preferred.

Minimum Requirements: (Network Data Specialist II) Requires a H.S. diploma and a minimum of 3 years related experience; or any combination of education and experience, which would provide an equivalent background.

Minimum Requirements: (Network Data Specialist Sr) Requires a H.S. diploma and a minimum of 3 years Provider Database Rep experience; or any combination of education and experience, which would provide an equivalent background.

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. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

REQNUMBER: PS74047-Georgia

Job Detail

• Company:
  Anthem, Inc.

Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

Location - Remote Nationwide

Be part of an extraordinary team.

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving high-performance culture that empowers you to make an impact?

The Beacon Health Options (Beacon) Medicare Compliance Consultant Senior will work closely with the Beacon Medicare Compliance Officer to monitor compliance with Medicare Advantage and Medicare-Medicaid Plan requirements.

Consultant will advise internal business units on Medicare operational compliance, reporting and audits (CMS Program Audits (ODAG/SARAG) and Part C Data Validation).

Essential Duties and Responsibilities Primary duties may include, but are not limited to: - At the most senior advanced level, report, communicate, research laws, regulations, requirements, regulatory audits and/or exams. - Provide senior level analytical support to projects, initiatives, regulatory audits or client oversight audits, internal audits,on-site reviews and, risk assessments. - Utilize systems unique to job functions, including standard-issue software such as Microsoft products including SharePoint; maintain system documentation, serve as subject matter expert, train users of system, contribute to system design, oversight or maintenance. - Apply critical thinking to formulate strategies and concepts that drive results, persuade and influence others, adapt to change, and manage conflict.

Qualifications

- Requires a BA/BS and minimum of 5 years health care, regulatory, ethics, compliance or privacy experience; or any combination of education and experience, which would provide an equivalent background. - Ability to travel may be required.

Preferred Qualifications: - In-depth knowledge of Medicare health plan operations, reporting and audits including CMS Program Audits (ODAG/SARAG protocols) and Part C technical specifications. - A combination of appeals and grievances, claims, clinical, customer service, provider relations, and/or compliance functions in a Medicare Advantage /delegated Medicare Advantage environment required. - Preference will be given to candidates with certifications such as Certified in Healthcare Compliance (CHC)R or Certified Compliance & Ethics Professional (CCEP)R

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.

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.

Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

REQNUMBER: PS74267-California

Job Detail

• Company:
  Anthem, Inc.

Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

Approver Sr. Dearborn, MI 48120

Be part of an extraordinary team. We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

The Disability Care Coordinator/Senior Approver (Union Role) -DCC is responsible for the management of Disability claims for group policy holders to include investigation, documentation, and authorization of payment. The DCC also pays claims and completes minor adjustments. There is constant interaction with claimants, medical professionals, and other vendors. DCC will handle statutory, occupational, and non-occupational claims as well as claims that fall outside duration guidelines.

Duties and Responsibilities:

• Responsible for adjudicating all STD claims in a timely manner

• Manage claims in accordance with company standards, which includes the Statement of Work and Client Contract Plan Language

• Providing excellent customer service

• Gather clinical and confirm eligibility information to verify approved period of disability

• Maintain awareness of the ERISA, Fair Claims Practices Model Act, privacy regulations, and state-mandated laws, and abides by them as dictated by each individual claim

• Actively enlist the services of support services (Physician Advisor, Vocational Rehabilitation, etc.) to assist with claim management

• Ability to interact with treating sources to negotiate appropriate treatment plan and return to works

• Responsible for timely and accurate payment of Disability claims

• Ability to determine and withhold FICA, Federal and State Levies

• Determine and calculate appropriate offsets

• Correspond via letter and telephone with employee, physicians, employers, hospitals, rehabilitation, and other vendors to obtain claim information

• Is responsible for mailing appropriate state program forms as well as required company disability forms to the employee

• General claims support duties to include telephone coverage

• Other duties as assigned

Qualifications

• High School Diploma

• Preferred: BA and/or equivalent work experience

• Comprehensive knowledge of group insurance principles and practices

• Proficient contractual understanding of group Disability product

• Basic computing and keyboarding skills required with proficiency in Word and Excel

• Excellent oral and written communication skills including active listening

• Ability to make timely and effective decisions

• Ability to work independently as well as working effectively in a team environment

  Knowledge/Experience:

• Provides superior, professional, and courteous service to our customers

• Provides timely and accurate resolution of inquiries and issues regarding claim payment regarding benefits, policies, and contracts

• Handles complex calls and situations by taking ownership of issues to ensure timely resolution or follow-up

• Conducts research and resolves issues

• Participates in specials projects assigned

• Demonstrates full competence in own work area

• Makes significant contribution to work team

• Performs other duties as assigned

  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.

  The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state, and local laws.

  Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

  REQNUMBER: PS74351-US

Job Detail

• Company:
  Anthem, Inc.

Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

Job Title: UX Designer Senior

NOTE: Please include a link to your portfolio on your resume or cover letter.

Be part of an extraordinary team.

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Responsible for the navigation, organization and interaction design for leading-edge web solutions and applications. Applies user-centered design methods to translate user needs, business objectives and technology capabilities into best in class user experiences.

Primary duties may include, but are not limited to:

• Responsible for creating and maintaining the design system that all product design teams, engineers, and product managers use to design and develop products.

• Works with other designers, digital product managers and technology teams to create and implement best in class design solutions across our product lines.

• Use of visual design and problem-solving skills to deliver a cohesive and compelling UI Kit for a new generation of data-intensive, digital products used by healthcare professionals, practices, and patients.

• Designs web and mobile layouts, designs conversions across devices, and supports supplementary design requirements, like photo editing and preparing comps for presentations.

• Design visual language and UI components that are approachable and aesthetic

• Works with senior designers to produce style guidelines defining our products visual identity.

• Creates the best design production based on project needs that will help people understand complex data towards improving members health.

• Mentors and provides guidance to junior designers.

Qualifications

+ + Requires a BA/BS in a design discipline

• Minimum of 10 years experience, including minimum of 8 years leading and contributing to creative projects resulting in proven successful outcomes for users and the business.

• Or any combination of education and experience, which would provide an equivalent background.

• Agile certification preferred.

• Experience with designing UI components that adhere to ADA & WCAG accessibility requirements

  Preferred Skills:

• A track record that demonstrates exceptional visual design skills that show mastery in presenting complex visual information with awareness for information hierarchy, flow and context, including states and transitions.

• Strong rapid visualization skills for quickly generating, iterating, and visually pitching your ideas as concept sketches, storyboards, etc.

• The ability to work comfortably in a wide array of styles

• Flexibility in your ability to work at the appropriate level of visual fidelity (thumbnailing, sketching, wireframing, designing and polishing).

• Experience designing digital products for Health care

• Illustration skills, ability to create iconography that would be used in the UI Kit

• Experience in B2B environments, healthcare or other regulated sectors is a plus

  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. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

  REQNUMBER: PS73718-California

Job Detail

• Company:
  Anthem, Inc.

Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

Be part of an extraordinary team!

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change.

Do you want to be part of a larger purpose and an evolving high-performance culture that empowers you to make an impact?

Responsible for providing technical leadership and setting strategic direction of projects.

Primary duties may include, but are not limited to: - Manages close processes, related analysis and reporting. - May lead teams of associates. - Prepares and reviews journal entries and reconciliations. - Prepares and reviews monthly and quarterly financial reports and complex analysis. - Designs research plans for data gathering and analysis and manages projects to deadlines. - Responsible for initiation and resolution of complex accounting problems requiring technical expertise. - Mentors, trains, and coaches lower-level accountants. - Ability to work cross-functionally or across departmental boundaries to represent BlueCard, providing Subject Matter Expertise

Qualifications

- Requires BA/BS in Accounting or Finance, or related field and a minimum of 5 years' experience in general accounting, finance or budgeting and planning in a large for-profit organization; or any combination of education and experience, which would provide an equivalent background. - CPA, CMA, or MBA preferred.

If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a 'sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions.

Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.

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.

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.

Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

REQNUMBER: PS74299-Georgia

Job Detail

• Company:
  Anthem, Inc.

Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

Location - Remote Nationwide

Be part of an extraordinary team.

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving high-performance culture that empowers you to make an impact?

The Beacon Health Options (Beacon) Medicare Compliance Consultant Senior will work closely with the Beacon Medicare Compliance Officer to monitor compliance with Medicare Advantage and Medicare-Medicaid Plan requirements.

Consultant will advise internal business units on Medicare operational compliance, reporting and audits (CMS Program Audits (ODAG/SARAG) and Part C Data Validation).

Essential Duties and Responsibilities Primary duties may include, but are not limited to: - At the most senior advanced level, report, communicate, research laws, regulations, requirements, regulatory audits and/or exams. - Provide senior level analytical support to projects, initiatives, regulatory audits or client oversight audits, internal audits,on-site reviews and, risk assessments. - Utilize systems unique to job functions, including standard-issue software such as Microsoft products including SharePoint; maintain system documentation, serve as subject matter expert, train users of system, contribute to system design, oversight or maintenance. - Apply critical thinking to formulate strategies and concepts that drive results, persuade and influence others, adapt to change, and manage conflict.

Qualifications

- Requires a BA/BS and minimum of 5 years health care, regulatory, ethics, compliance or privacy experience; or any combination of education and experience, which would provide an equivalent background. - Ability to travel may be required.

Preferred Qualifications: - In-depth knowledge of Medicare health plan operations, reporting and audits including CMS Program Audits (ODAG/SARAG protocols) and Part C technical specifications. - A combination of appeals and grievances, claims, clinical, customer service, provider relations, and/or compliance functions in a Medicare Advantage /delegated Medicare Advantage environment required. - Preference will be given to candidates with certifications such as Certified in Healthcare Compliance (CHC)R or Certified Compliance & Ethics Professional (CCEP)R

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.

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.

Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

REQNUMBER: PS74267-California

Job Detail

• Company:
  Anthem, Inc.

Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

CareMore Care Management Manager I Location: Position will work primarily from home, with occasional travel to CareMore clinics.

Be part of an extraordinary team We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Build the Possibilities. Make an extraordinary impact. CareMore is a proud member of the Anthem family of brands, offering clinical programs and primary care options for seniors. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery.

We are hiring a Manager I - Care More Care Management. Responsible for managing the implementation of clinical protocols and programs. How you will make an impact:

• Manages quality improvement, resource management, cost containment, case management, and member and provider grievance resolution.

• Assists in managing department policies and procedures, clinical data analysis, ancillary contract implementation, and provider education.

• Assists in creating annual Case Management (CM) work plan, quarterly reports, and annual evaluations.

• Manages the implementation of CM programs and monitors and recommends modifications.

• Represents the Health Plan in vendor meetings.

• Attends meetings and medical management committees.

• Collaborates with local physicians to provide support for positive member outcomes.

• Evaluates CM system/clinical operation effectiveness and presents findings to management.

• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Qualifications

Minimum Requirements:

• Requires an RN and minimum of 4 years of experience; or any combination of education and experience, which would provide an equivalent background.

• 1-2 years of case management experience.

• Current unrestricted RN license in CA required.

• For CareMore business units, satisfactory completion of a Tuberculosis test is a requirement for this position.

Preferred Qualifications:

• BS in Nursing preferred.

• Leadership experience preferred.

• Case management certification 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. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

REQNUMBER: PS73346

Job Detail

• Company:
  Anthem, Inc.

Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

Job Title: UX Designer Senior

NOTE: Please include a link to your portfolio on your resume or cover letter.

Be part of an extraordinary team.

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Responsible for the navigation, organization and interaction design for leading-edge web solutions and applications. Applies user-centered design methods to translate user needs, business objectives and technology capabilities into best in class user experiences.

Primary duties may include, but are not limited to:

• Responsible for creating and maintaining the design system that all product design teams, engineers, and product managers use to design and develop products.

• Works with other designers, digital product managers and technology teams to create and implement best in class design solutions across our product lines.

• Use of visual design and problem-solving skills to deliver a cohesive and compelling UI Kit for a new generation of data-intensive, digital products used by healthcare professionals, practices, and patients.

• Designs web and mobile layouts, designs conversions across devices, and supports supplementary design requirements, like photo editing and preparing comps for presentations.

• Design visual language and UI components that are approachable and aesthetic

• Works with senior designers to produce style guidelines defining our products visual identity.

• Creates the best design production based on project needs that will help people understand complex data towards improving members health.

• Mentors and provides guidance to junior designers.

Qualifications

• Requires a BA/BS in a design discipline

• Minimum of 10 years experience, including minimum of 8 years leading and contributing to creative projects resulting in proven successful outcomes for users and the business.

• Or any combination of education and experience, which would provide an equivalent background.

• Agile certification preferred.

• Experience with designing UI components that adhere to ADA & WCAG accessibility requirements

  Preferred Skills:

• A track record that demonstrates exceptional visual design skills that show mastery in presenting complex visual information with awareness for information hierarchy, flow and context, including states and transitions.

• Strong rapid visualization skills for quickly generating, iterating, and visually pitching your ideas as concept sketches, storyboards, etc.

• The ability to work comfortably in a wide array of styles

• Flexibility in your ability to work at the appropriate level of visual fidelity (thumbnailing, sketching, wireframing, designing and polishing).

• Experience designing digital products for Health care

• Illustration skills, ability to create iconography that would be used in the UI Kit

• Experience in B2B environments, healthcare or other regulated sectors is a plus

  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.

  The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.

  Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

  REQNUMBER: PS73719

Job Detail

• Company:
  Anthem, Inc.

Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

Be part of an extraordinary team! We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving high-performance culture that empowers you to make an impact?

Job Description: Responsible for acting as a member of the Agile leadership team and is the functional and/or client (or business) representative for a project or set of projects within a market-focus.

Primary duties may include, but are not limited to: - Translating features into user stories within a teams backlog and managing ranking and prioritizing this backlog so that it is reflective of stakeholder requirements and priorities. - Final testing and acceptance of the user stories supporting the features. - Effectively communicate to the team the stakeholder needs so the teams delivery meets both contractual requirements and established acceptance criteria including expected quality and performance, and to complete various work management activities according to defined service level commitments and process compliancy guidelines. - Collaborate with team(s) to discover and deliver the best solution to the market problem(s) presented by the Product Manager (business). - Works with the business to understand, rank and prioritize business needs and plan solutions to ensure that each release provides business value to end users sales and marketing. - Manage the solution concept development process to ensure the product team understand the direction and vision. - Create and maintain regularly the solution vision roadmap and backlog of work through the project's life cycle. - Understands how to write user stories and their acceptance criteria. - Translates the product backlog into user stories. Serve as the Product Management (business) proxy and decision point to represent the stakeholders in the project. - Reviews and accepts/rejects results both during a Sprint and in the Sprint review. - Attends sprint ceremonies and is available to team during the sprint for clarifications and acceptance of user stories. - Creates and/or inputs into a projects release plan. - Presents work to team from Team Backlog during Sprint Planning for acceptance by the Team in a Sprint negotiates Sprint goals with the Team.

Qualifications

Minimum Qualifications: - Requires a BA/BS and minimum of 3 years' experience with writing business/functional requirements and experience implementing Agile methodologies; or any combination of education and experience, which would provide an equivalent background.

Preferred Qualifications: - Leading SAFe (SA) certification, CSPO or equivalent (Certified Scrum Product Owner) and/or SPO/PM (SAFE Product Owner/Product Manager) strongly 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.

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.

Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

REQNUMBER: PS73667-Georgia

Job Detail

• Company:
  Anthem, Inc.