Vacancy caducado!
Description SHIFT: Day JobSCHEDULE: Full-timeYour 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.Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 Diversity Inc 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.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. 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.
The ideal candidate will have strong verbal and written communication
skills to be able to effectively provide constructive feedback. Experience with MS Word, Excel and Outlook,
along with Medicaid and Medicare, WGS, Facets, Medisys and CS90 is
preferred. Additionally, this candidate
will have an understanding of different audit methodologies and claims
processing experience.AnEqualOpportunityEmployer/Disability/VeteranQualifications
Requires high school diploma or equivalent(GED);
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;
Working knowledge of insurance industry and medical/Rx drug terminology;
Detailed 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
REQNUMBER: PS36603
Vacancy caducado!