Reno, Nevada

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 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

 

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

  • Develops and maintains positive provider relationships with provider community by regular on-site and/or virtual/digital visits, communicating administrative and programmatic changes, and facilitating, education and the resolution of provider issues.
  • Serves as a knowledge and resource expert regarding the most complex provider issues impacting provider satisfaction; researches and resolves the most complex provider issues and appeals for prompt resolution.
  • Works with internal matrix partners to triage issues and submit work requests.
  • Is assigned higher level, Tier 1/Platinum providers, but will handle Tier 2’s as well.
  • Functions as a high level technical resource to resolve or facilitate complex provider issues.
  • Coordinates Joint Operation Committees (JOC) of Tier 1 /Platinum provider groups, driving the meetings in the discussion of issues and changes.
  • Provides assistance regarding Annual Provider Satisfaction Surveys and required corrective action plan implementation and monitoring, education, contract questions 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.
  • Organizes and executes external Provider Townhalls/Seminars and attends State Association conferences (e.g.: MGMA, AFP, AAP, HFMA).
  • 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; 5 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.



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.

Reno, Nevada

If you’re a reserve or veteran member of the military, 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 with operations experience.  Whether your experience is hands-on as an operational specialist or in operational leadership, 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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