, Florida

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision.  At CareMore, a proud member of the Anthem, Inc. family of companies, 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.

CareMore is a proven care delivery model for the highest-risk.  We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery.  We build and lead integrated, multi-disciplinary clinical teams to care for the most complex patients.  We strive for excellence and have achieved significant and measurable improvement in total cost of care, clinical outcomes, and experience.  As an Anthem subsidiary, we benefit from the scale and resources one of America’s largest managed healthcare organizations.

Remote/Telecommute position- $1,000 Sign-On Bonus

The Manager, Claims Audit is responsible for providing oversight of the high dollar audit claim staff.
Primary duties may include but are not limited to: 
•managing the standardized end-to-end prepayment audit of all claims meeting the high dollar threshold. 
•Preventing incorrect claim payments, reducing prepayment error rates and improving quality. 
•Prepares specialized reports, captures discrepant error detail and captures the prepayment savings reporting used by Enterprise. 
•Interacts daily with Account Management and Provider Contracting. 
•Must be well versed in facility reimbursement arrangements which may include but not be limited to; DRG pricing, case rate, CBC (Covered Billed Charges) as well as discount off of charge. 
•Must understand and be well versed in the Stop Loss policies of large ASO accounts. Hires, trains, coaches and manages the performance of all direct reports. 

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.

Qualifications

Qualifications:
•Requires BA/BS degree and a minimum of 3 years previous management experience and a minimum of 2 years claims experience; or any combination of education and experience which would provide an equivalent background.
Preferred Qualifications:
•Medicare claims processing experience

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.

, Florida

If you are active-duty military, reserve, or a military veteran, we foster a welcoming environment that’s dedicated to honoring your service and helping you achieve your career goals. Veterans of Anthem — one of our Business Resource Groups — partners with our Talent Acquisition teams to maximize career offerings for you and your family members, striving to help you transition to civilian service and grow your career at the same time. 

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

WE ARE HIRING

Anthem, Inc. is currently seeking military veterans and military spouses for a variety of open roles.  Our immediate needs include Support Technical Engineer, Lead Engineer, Developer, Systems Analyst, Network Data Specialist, and Provider Network Manager roles.  Whether you are looking to transition into an IT career or if you have experience under your belt in the Technology field, Anthem wants to have an impact on your career and professional growth by speaking with you about their career opportunities.

If you are interested in learning more, check out Anthem's current open positions to the right for more information and to apply today!

Not sure where to start?  Send RecruitMilitary Success Manager, Taylor Groves, your questions at taylor.groves@recruitmilitary.com 

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