Anthem Inc. Veterans Jobs

Job Information

Anthem, Inc. Performance Quality Auditor I, II, III-PS59113 in Seattle, Washington

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.

As a Performance Quality Auditor you will be responsible for evaluating the quality of services and interactions provided by organizations within the enterprise. Included are processes related to enrollment and billing and claims processing, as well as customer service written and verbal inquiries.

Level I - Primary duties for may include, but are not limited to:

  • Evaluates the quality and accuracy of transactions and/or communications with providers, groups, and/or policyholders.

  • Identifies, documents, and reports any transaction errors or communications issues in a timely manner to ensure prompt resolution.

  • Tracks and trends audit results, providing feedback to management.

  • Identifies and reports on systemic issues which create ongoing quality concerns.

  • Generates monthly reports of audit findings, supports clients with issues identified and develops reports to assist management with information requested.

  • Produces other ad hoc reports as requested by internal and/or external clients.

  • Associates at this level conduct routine audits, generally related to a single function on a single systems platform for a single line of business.

    Level II Primary duties may include, but are not limited to:

  • Evaluates the quality and accuracy of transactions and/or communications with providers, groups, and/or policyholders.

  • Identifies, documents, and reports any transaction errors or communications issues in a timely manner to ensure prompt resolution.

  • Tracks and trends audit results, providing feedback to management.

  • Identifies and reports on systemic issues which create ongoing quality concerns.

  • Generates monthly reports of audit findings, supports clients with issues identified and develops reports to assist management with information requested.

  • Produces other ad hoc reports as requested by internal and external clients.

  • Associates at this level conduct routine to complex audits, generally related to one or more functions on one or more systems platform for one or more lines of business.

    Level III Primary duties may include, but are not limited to:

  • Evaluates the quality and accuracy of transactions and/or communications with providers, groups, and/or policyholders.

  • Identifies, documents, and reports any transaction errors or communications issues in a timely manner to ensure prompt resolution.

  • Tracks and trends audit results, providing feedback to management.

  • Identifies and reports on systemic issues which create ongoing quality concerns.

  • Generates monthly reports of audit findings, supports clients with issues identified and develops reports to assist management with information requested.

  • Produces other ad hoc reports as requested by internal and external clients.

  • Provides training, mentoring and support to quality staff.

  • Associates at this level function as subject matter experts, conducting routine to complex audits, generally related to multiple functions on multiple systems platform for multiple lines of business.

  • Works proactively and independently including facilitation of calibration sessions with clients and/or teams.

    Here’s what Anthem offers:

  • A career path with opportunity for growth

  • Ability to obtain your Associate’s or Bachelor’s degree or further your education with tuition reimbursement.

  • Affordable Health Insurance, Dental, Vision and Basic Life

  • 401K match, Paid Time Off, Holiday Pay

  • Quarterly incentive bonus and annual increases plan based on performance.

    At Anthem, the team is comprised of the best and the brightest from diverse experiences, cultures, and backgrounds. The differences we each bring to the table are a part of what makes our company so successful.

Qualifications

Required Qualifications

  • Requires high school diploma or equivalent (GED)

  • (Level I) 2 years experience with the company in an enrollment and billing, claims and/or customer contact automated environment (preferably in healthcare or insurance sector) or any combination of education and experience, which would provide an equivalent background.

  • (Level II) 3 years experience including a minimum of 1 year related experience in a quality audit capacity (preferably in healthcare or insurance sector) with consistent above target performance;

  • (Level III) 5 years experience including a minimum of 2 years experience as a Quality Auditor II with consistent above target performance; working knowledge of insurance industry and medical terminology

    Preferred Qualifications

  • Bachelors degree preferred

  • Working knowledge of insurance industry and medical terminology

  • Working knowledge of relevant systems and proven understanding of processing principles, techniques and guidelines

  • Ability to acquire and perform progressively more complex skills and tasks in a production environment

    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. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s 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.

    REQNUMBER: PS59113

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