Anthem, Inc. Compliance Manager in Modesto, California
SHIFT: Day Job
Your Talent. Our Vision. At CareMore, a proud member of the Anthem, Inc. family of companies specializing in providing senior Americans a complete and pro-active health care experience, it’s a powerful combination. It’s 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.
This position is open to remote in a PST geographical area with Cerritos, CA preferred.
Responsible for managing foundational and strategic compliance responsibilities with consistent excellence that support the team and management.
Primary duties for this managing level position, with moderate to advanced complexity and broad/enterprise scale may include, but are not limited to:
Manage/oversee projects, initiatives, regulatory audits or exams, internal audits, accreditations, on-site reviews, risk assessments; audit planning, conducting mock audits, conducting audit training, managing audit evidence preparation, assessing audit preparedness.
Establish project plans, gap analysis, milestone dates, and other significant aspects, and leadership updates.
Maintain knowledge of laws, regulations, company strategies to assess impact, and consult with clients as subject matter expert.
Conducts complex investigations, document findings, and ensure corrective actions are made.
Interface with external clients, regulators, vendors, supplier; internal stakeholders, high level of management.
Requires a BA/BS; MS/MBA/JD or professional designation preferred; at least 6+ years of 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.
Experience supporting Claims during CMS Program Audits of Medicare Advantage Plans is strongly preferred for this role.
Thorough understanding of Medicare guidelines and reporting requirements for Claims in a Medicare Advantage Plan/MSO Organization preferred.
Excellent verbal and written communication skills required.
Ability to present across all levels of the business from colleagues to executive business leaders.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.