Anthem Process Expert II (CT, VA, OH, FL & TN) - PS14569 in Ashburn, Virginia
Process Expert II (CT, VA, OH, FL & TN) - PS14569
Location: Virginia, United States
Field: Business Support
Requisition #: PS14569
Post Date: 6 days ago
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care .
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.
Supports a single operations department by participating in project and process work.
Primary duties may include, but are not limited to:
Researches 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
Member Experience / Star Ratings
Medicare and Medicaid Grievance/Appeals documentation.
Medicare and Medicaid communications (review, redesign, approval process)
Understanding of Medicare & Medicaid Regulations
Requires a BA/BS degree; 5-7 years experience in business analysis, process improvement, project coordination in a high-volume managed care operation (claims, customer service, enrollment and billing) with the ability to analyze workflows, processes, supporting systems and procedures and identifying improvements; or any combination of education and experience, which would provide an equivalent background.
Must have strong writing & communication skills
Must have Knowledge/ Experience in dealing with Medicare Advantage (MA), Medicare Supplement (Med Supp) and Medicare-Medicaid Plans (MMP) Enrollee marketing materials and correspondence
Must have Knowledge/Experience with the PEGA processing system.
Must have Experience with both Medicare & Medicaid Appeals & Grievance processing.
Must have Experience with both Medicare & Medicaid member materials regulations specifically.
Must have Experience with project managing
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran