, Ohio

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 care companies and a Fortune Top 50 Company

Location: Ohio (Anthem Office location) 

The Manager II, Grievance/Appeals position is responsible for management oversight of clinical and non-clinical appeals and grievance work conducted by employees within the Central Region. The manager will oversee the work conducted to resolve, and respond timely to Member and Provider appeals, Member grievances and ensure compliance with regulatory and contractual requirements.
Primary duties may include, but are not limited to:
•    Maintains and coordinates staff activities to achieve departmental and corporate goals to improve service to members/providers and assures regulatory and accreditation compliance.
•    Analyzes and develops strategies by achieving performance thresholds within budgetary guidelines.
•    Addresses both internal/external member/provider needs and concerns related to team activities.
•    Monitors data trends, conducts root cause analysis of appeals and grievance data.
•    Use data trends and analysis to drive daily regional staffing assignments.
•    Leads performance improvement efforts based on data findings to create standard work and process efficiencies.
•    Present data trends and analysis to both internal and external stakeholders.
•    Hires, trains, coaches, counsels, and evaluates performance of direct reports.
 

Qualifications

Requires 5 + years grievance & appeals experience and 3-5 years of management experience with direct reports in the healthcare industry; or any combination of education and leadership experience, which would provide an equivalent background will be considered.
Key Qualifications:
•    Must reside in the State of Ohio
•    10+ years of RN experience strongly preferred
•    Analytical skills and critical thinking skills
•    Experience with small/large group presentations
•    Self-motivated, organized and independent thinker
•    Excellent problem solving skills
•    Ability to manage multiple tasks with time sensitive deadlines
•    Previous experience conducting appeals and grievance work in a managed care setting
•    Experience with MS Office (Word, Excel, Outlook, Power Point)
•    Tableau Experience
•    Experience in leading large scale process improvement efforts

 

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.

, Ohio

As one of America’s largest health benefits companies, we at Anthem have a profound appreciation for service. Our organization proudly supports our Nation’s active, reserve, and veteran military service members and their spouses.

This is an exciting opportunity to advance your life and career, while still protecting and serving others. Come see for yourself why Anthem is recognized as a Top Employer by GI Jobs and among the “Best of the Best: Top Veteran Friendly Companies” by US Veterans Magazine.

Who We Are Looking For 

Anthem, Inc. is seeking military veterans across the country who bring a deeply rooted skillset that includes team-oriented approaches to problem-solving, demonstrations of leadership and an overall commitment to the mission of the organization.  If you are a military veteran or military veteran spouse, Anthem, Inc. is looking to hire you.

Join Anthem's Military and Veteran Talent Network: https://anthemcareers.ttcportals.com/pages/military

Should I Apply?

Are you a transitioning member of the military or a military veteran who is looking for a civilian career that provides opportunities for growth and career advancement?  Anthem, Inc. is currently looking for job seekers with  Operations experience.  If you are interested in a career in one of these fields, check out our current open positions to the right for more information and to apply today!

What Happens After I Apply?

Once you click ‘Apply Now’ on an Anthem, Inc. job posting, you will be re-directed to fill out an application on Anthem's career page.  In order to be considered for next steps, please complete the application on Anthem's career page and make sure you have an updated resume uploaded to your RecruitMilitary profile.  Once Anthem, Inc. reviews your resume and profile, a recruiter will reach out to provide you with more information and to schedule you for an interview.

How to Win An Interview

1.     Review the job description for the specific position you are applying for.

2.     Review the company website. Know their mission and values. What do they do? What are their products?

3.     Prepare a few questions to ask on your interview.

4.     Prepare to discuss your military or civilian background and how it relates to the position. 

5.     Check out our Resources tab for resume guidance, interview prep and more!

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