Glendale, California

Description

SHIFT: Day Job

SCHEDULE: Full-time

Responsible for providing quality, accessible and comprehensive service to the company's provider community.

  • Develops and maintains positive provider relationships with provider community via a mixture of email, telephonic and face-to-face outreach, by communicating administrative and programmatic changes, and facilitating education and the resolution of provider issues. '
  • Serves as a knowledge and resource expert regarding provider issues impacting provider satisfaction; researches and resolves complex provider issues and appeals for prompt resolution.
  • Works with internal matrix partners to triage issues and submit work requests.
  • Assigned to Tier 2 and 3 providers.
  • Researches, analyzes and recommends resolution for contract dispute, non-routine claim issues, billing questions and other practices.
  • Coordinates communication process on such issues as administrative and medical policy, reimbursement and provider utilization patterns.
  • Conducts routine outreach to support the understanding of managed care policies and procedures.
  • Coordinates and conducts provider training including developing and distributing provider relations materials.
  • Provides assistance regarding Annual Provider Satisfaction Surveys and required corrective action plan implementation and monitoring, education, and non-routine claim issues.
  • Coordinates communications process on such issues as administrative and medical policy, reimbursement and provider utilization patterns.
  • Coordinates Provider Manual updates/maintenance.
  • Coordinates prompt claims resolution through direct contact with providers, claims, pricing and medical management department.
  • Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery.
  • Researches issues that may impact future provider negotiations or jeopardize network retention.

Qualifications

Requires a Bachelor's degree; 3 years of customer service experience including 2 years of experience as a Network Management Rep; or any combination of education and experience, which would provide an equivalent background. Travel may be required.

Preferred: 

  • Knowledgeable in the Medicaid sector with equivalent experience working with a Provider Medical Group (PMG), Independent Physician Association (IPA), Management Services Organization (MSO), and/or a Hospital Systems.
  • Familiar with California State Agencies including the Dept. of Managed Health Care (DMHC), Dept. of Health Care Services (DHCS), and local Southern California health plan models (i.e. Two Plan Model, LA Care Health Plan)



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.

Glendale, California

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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