Anthem, Inc.is one of the nation's leading health benefits companies and a Fortune Top 50 company. At Anthem, Inc., we are working together to transform health care with trusted and caring solutions.
Bring your expertise to our innovative culture where you will have the opportunity to make a difference in people's lives, and to take your career further than you can imagine.
Metrics Advisor, Senior or Metrics Executive Advisor-may be located at any Anthem location or work from a home office
Works as part of a financial performance reporting team to support the Program Integrity division in combatting Healthcare Fraud, Waste, and Abuse; ensuring that proper payments are being made to legitimate providers for reasonable services provided to eligible members.
Creates World Class monthly financial reporting packages, including Tableau Dashboards, to track Program Integrity Functional Area (FA) actual performance vs. Cost of Care and Total Program Savings targets. Creates budgets and financial forecasts for Program Integrity FAs. Interacts heavily with Program Integrity FAs, acting as a financial consultant to assist FAs in achieving goals. Supports Anthem Transformation efforts, acting as part of a team to provide WAVE L2 and other Financial Coaching to PI FAs. Communicates financial results to FAs, management, and other stakeholders.
Understands, predicts and implements measures to control healthcare costs and to make healthcare more affordable for Anthem's members. Understands, and is able to describe data nuances, caveats, and sources, and help drive data credibility process improvement.
Primary duties may include, but are not limited to:
Provides financial reporting and technical support for the Program Integrity division in achieving Cost of Care and other financial targets
Interacts frequently with business partners, assisting in identifying financial savings opportunities (sub-optimal system edits, waste, fraud, overpayments) including mining EDWard/other data sources
Supports Anthem Transformation efforts via L2 Financial Coaching for Program Integrity FAs
Works as part of a team to create and enhance monthly financial reporting packages, including Tableau Dashboards and reporting suites for Program Integrity FAs, including;
o Coordination of Benefits
o Reimbursement Policy and Claims Editing
o Provider Audit
o Special Investigations Unit
Assists in the identification of potential Cost of Care savings opportunities through complex analytics via partnering with the Cost of Care analytics team, developing action plans, benefits and risk assessments, and overseeing and partnering with the actuarial team to develop and ensure accurate savings quantification.
Plans, leads and oversees cost of care planning meetings and tracks and reports on Cost of Care projects
Dependent on experience may hire at either Metrics Advisor Sr. or Metrics Executive Advisor:
Team player with a positive, "can do" attitude
Strong financial/analytics acumen required
Requires a BS/BA degree
Advanced degree; MBA, MPH, MHA, or MA preferred
Expertise with Tableau strongly preferred
Best in Class communication skills required
At least 8 - 10 or more years of data collection and financial reporting/analysis experience or relevant experience in Health Care; or any combination of education and experience, which would provide an equivalent background.
Experience presenting financial analysis to senior leadership strongly preferred
Healthcare experience is required, managed care experience is preferred
Prior experience with Program Integrity, Cost of Care reporting, provider networks, claims, finance, and operations strongly preferred
EDWard competency and programming expertise and including SAS, SQL, etc, strongly preferred
/ Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine, and is a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran. /
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Equal Employment Opportunity Statement
Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.
Title: Metrics Advisor, Senior or Metrics Executive Advisor -137204
Requisition ID: 137204
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