Anthem Inc. Virginia Jobs

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Anthem, Inc. Quality Configuration Audit Associate/Senior in Alexandria, Virginia

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.

PS54084 Quality Configuration Audit Associate

Responsible for driving service quality excellence by evaluating the quality of services and interactions provided by organizations within the enterprise. Included are processes related to provider and pricing configuration and respective downstream processes, as well as provider inquires.

Primary duties may include, but are not limited to:

  • Assists higher level auditor/lead on field work as assigned and acts as auditor in charge on small and less complex audits.

  • Participates in pre and post production audits of provider pricing configuration in Anthem’s pricing systems.

  • Demonstrates ability to audit multiple lines of business, multiple functions, and multiple systems.

  • Analyzes and interprets data and makes recommendations for change based on judgment and experience, applies audit policy, and assesses risks to minimize our exposure and mitigate those risks.

  • Works closely with the business to provide consultation and advice to management related to policy and procedure identified as out of date or incomplete and investigates, develops and recommends process improvements and solutions.

  • Functions as a subject matter expert for discrepancy review, questions from team and business partners, and interpretation of guidelines and audit process.

  • Acts as a mentor to peer auditors, providing training and managing work and projects as necessary.

    PS54084 Quality Configuration Audit Senior

    Primary duties may include, but are not limited to:

  • Acts as auditor in charge for audits and special projects, producing engagement planning and testing strategies.

  • Translates business need into appropriate, comprehensive quality validation strategies and design.

  • Participates in pre and post production audits of provider pricing configuration in Anthem’s pricing systems.

  • Audits multiple lines of business, multiple functions, and multiple systems.

  • Trend audit results and perform data analysis on trends to determine/recommend adjustments to quality reviews.

  • Work closely with the business to provide consultation and advice to management related to policy and procedure identified as out of date or incomplete and investigates, develops and recommends process improvements and solutions.

  • Manage process improvement process; may include activities such leading workgroups, facilitating SWAT sessions, drafting new workflow or procedures.

  • Functions as a subject matter expert for discrepancy review, questions from team and business partners, and interpretation of guidelines and audit process.

  • Facilitate and lead meetings with business to review audit plan, audit findings and/or recommendations for improvement.

  • Acts as a mentor to peer auditors, providing training and managing work and projects as necessary.

  • Facilitate calibration sessions with the business area, support areas, vendors or clients.

Qualifications

PS54084 Quality Configuration Audit Associate

Requires a BS/BA; 3+ years related experience in provider or pricing configuration; or any combination of education and experience, which would provide an equivalent background.

PS54084 Quality Configuration Audit Senior

Requires a BS/BA; 4-5+ years related experience in provider or pricing configuration or any combination of education and experience, which would provide an equivalent background.

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.

REQNUMBER: PS54084-Virginia

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