Provider Contract/Cost of Care Consultant or Provider Contract/Cost of Care Analyst, Sr. - Military Veterans

at Anthem, Inc.

Waukesha, Wisconsin

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.

Job Description for Provider Contract/Cost of Care Consultant

Provides analytical support to the Cost of Care organizations. Focuses efforts on lowering claims costs, and improving the quality of care. Provides expert advice, analytic and consultative support to Medical Directors and management on cost of care issues. Works large scale Enterprise wide initiatives with high dollar cost savings opportunities. Acts as a source of direction, training, and guidance for less experienced staff.

This position manages the facility and professional provider trend, the annual weighted average payment increase, and the reporting process for Anthem's Central Region. The Central region is comprised of Ohio, Missouri, Indiana, Wisconsin, and Kentucky. The candidate will work with all leadership in these states to achieve Anthems' annual trend goal. This position will also support leadership by coordinating reporting for the Central markets for potential provider terminations and supports the cost of care for the Central region with ad hoc reporting.

Primary duties may include, but are not limited to:

  • Performing healthcare cost analysis to identify strategies to control costs.
  • Types of analyses include performing sophisticated retrospective data analytics.
  • Building new and modifying existing complex models to create predictive impact decision making tools.
  • Uses analytic tools to track both health risks and compliance.
  • Projecting cost increases in medical services by using analytic techniques for PMPM trending via multiple variable analysis.
  • Performing modeling to compare various contract scenarios based on member utilization patterns and 'what if' logic.
  • Projects different cost of care savings targets based upon various analytics.
  • Identifies cost of care savings opportunities by analyzing practice patterns in relation to office visits, referral practices, and specialty care procedures.
  • Recommends policy changes and claim's system changes to pursue cost savings.
  • Reviews results post-implementation to ensure projected cost savings are realized and recommends modifications as applicable.
  • Recommends standardized practices to optimize cost of care.

Job Description for Prov Contract/CofC Analyst, Sr.
Provides analytical support to the Cost of Care and/or Provider Contracting organizations. Focuses efforts on lowering claims costs and improving the quality of care.  Provides advice and analytic support to Medical Directors and management on cost of care issues to help reduce costs without compromising quality of care.

 

Primary duties may include, but are not limited to: 

  • Performs varied data analyses which may include:
    • Developing moderately complex ROI models and performs healthcare cost analysis to identify strategies to control costs.
    • Projecting cost increases in medical services by using analytic techniques for PMPM trending via multiple variable analysis.
  • Performing modeling to compare various contract scenarios based on member utilization patterns and 'what if' logic; 
  • Projecting different cost of savings targets based upon various analytics. 
  • Identifies cost of care savings opportunities by analyzing practice patterns in relation to office visits, referral practices, and specialty care procedures and recommends policy changes and claim's system changes to pursue cost savings. 
  • Reviews results post-implementation to ensure projected cost savings are realized and recommends modifications as applicable. 
  • Recommends standardized practices to optimize cost of care. 
  • Participates on project team involved with enterprise wide initiatives.

Qualifications

Qualification Requirements for Provider Contract/Cost of Care Consultant

  • Requires BS/BA degree in Mathematics, Statistics, or related field; minimum of 5 years experience in broad-based analytical, managed care payor or provider environment; considerable experience in statistical analysis and healthcare modeling; or any combination of education and experience, which would provide an equivalent background. Master's degree preferred.
  • Query tools experience preferred: SQL, SAS, or Teradata experience preferred.
  • Proficiency with Microsoft Excel, strongly preferred.

 

Qualification Requirements for for Prov Contract/CofC Analyst, Sr.

  • Requires BS/BA degree in Mathematics, Statistics, or related field; 3-5 years experience in broad-based analytical, managed care payor or provider environment; experience in statistical analysis and healthcare modeling; or any combination of education and experience, which would provide an equivalent background.
  • Query tools experience preferred: SQL, SAS, or Teradata experience preferred.
  • Proficiency with Microsoft Excel, strongly preferred.

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.

Waukesha, Wisconsin

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!

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