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Anthem, Inc. Clinical Audit Process Improvement Director in Dearborn, Michigan


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.

Location: Remote based

The Clinical Audit Process Improvement Director is responsible for identifying opportunities for improvement, developing and implementing best practice and continuous improvement initiatives for a business unit.

Primary duties may include, but are not limited to:

  • Proactively identifies opportunities for improvement; researches, develops, and implements related best practices.

  • Develops metrics to track performance and goal achievement

  • Serves as internal consultant relative to continuous improvement initiatives

  • Assists in optimizing coding and clinical audit concepts and auditor productivity

  • Identifies and develops plans to improve performance to be incorporated enterprise wide.


Minimum Requirements

  • Requires a BA/BS in a related field and minimum of 10 years of process improvement experience with planning, project management, business analysis, and leadership role experience; or any combination of education and experience, which would provide an equivalent background.

  • Ability to travel may be required.

    Preferred Qualifications

  • Master’s degree in informatics, computer science, coding or related fields strongly preferred.

  • Six Sigma Black Belt certification preferred.

  • Strong preference will also be given to candidates with experience in Alteryx, Python, R, Machinify, SaaS, SQL, medical claims coding terminology, MS-DRG, APR-DRG, AP-DRG, claim payment methodologies and inpatient medical claims audit.

    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 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: PS60433