Anthem Business Consultant/Business Analyst II/III - Remote in Metairie, Louisiana

Business Consultant/Business Analyst II/III - Remote

Location: United States

Field: Business Support

Requisition #: PS5657

Post Date: Oct 10, 2018

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 atone of America's leading health benefits companies and a Fortune Top 50 Company.

Business Analyst II

Primary duties may include, but are not limited to:

  • Analyzes and recommends Specific Software Requirements to Address Complex and varied Business

  • The ability to review existing logic and compare to what is needed for New Group Implantations, SSCR and POR, Waves that are applicable to WGS from to develop standard rules and pricing logic

  • Developing, maintain and Mixer keys to include the understanding of Local Provider networks, Employer Networks, Intra-Plan and ITS Host Business and non-par pricing

  • Developing, maintain and Mixer keys to include the understanding of Local Provider networks, Employer Networks, Intra-Plan and ITS Host Business and non-par pricing

  • Synchronizes data on all claims and provider databases and provides expertise

  • On business requirements for multiple business region as they are related to new Network Set-up and Mixer development

  • Identifies, analyzes, and resolves issues for Pricing / Provider as it relates to Pricing set-up for WGS pricing system Databases.

  • Participates in system testing and analysis in support of new functionality, new System processes, and business rules changes.

  • Validates the data to be housed on Member Mixer keys/ databases and ensures adherence to business and system requirements of customers as it pertains to Provider Networks,Employer Specific Networks,State Mandates and other requirements as they relate to Mixers Determines regional/cap/business indicators for multiple business areas

  • To assure accurate reimbursement based on provider contract and area fee schedules.

  • Loads or creates Mixer keys based on the requirements by multiple business areas.

Business Analyst III

Primary duties may include, but are not limited to:

  • Analyzes and Recommends Specific Software Requirements to Address Complex and varied Business

  • The ability to review existing logic and compare to what is needed for platforms that are converting to WGS from the other Anthem Platforms, to develop standard rules and pricing logic

  • Developing, maintain and Mixer keys to include the understanding of Local Provider networks, Employer Networks, Intra-Plan and ITS Host Business and non-par pricing

  • Development of the WGS Enhanced Pricier and West Pricier

  • Support of WGS Code Database logic as it pertains to system conversions

  • Synchronizes data on all claims and provider databases and provides expertise

  • On business requirements for multiple business region as they are related to new Network Set-up and Mixer development

  • Identifies, analyzes, and resolves issues for Pricing / Provider as it relates to Pricing set-up for WGS pricing system Databases.

  • Participates in system testing and analysis in support of new functionality, new System processes, and business rules changes.

  • Validates the data to be housed on Member Mixer keys/ databases and ensures adherence to business and system requirements of customers as it pertains to Provider Networks, Employer Specific Networks, State Mandates and other requirements as they relate to Mixers

  • Determines regional/cap/business indicators for multiple business areas To assure accurate reimbursement based on provider contract and area fee Schedules.

  • Loads or creates Mixer keys based on the requirements by multiple business areas.

Business Consultant

Primary duties may include, but are not limited to:

  • The ability to lead a team of Analyst assigned to Complex Projects

  • Analyzes and Recommends Specific Software Requirements to Address Complex and varied Business

  • The ability to review existing logic and compare to what is needed for platforms that are converting to WGS from the other Anthem Platforms, to develop standard rules and pricing logic

  • Developing, maintain and Mixer keys to include the understanding of Local Provider networks, Employer Networks, Intra-Plan and ITS Host Business and non-par pricing

  • Development of the WGS Enhanced Pricier and West Pricier

  • Support of WGS Code Database logic as it pertains to system conversions

  • Synchronizes data on all claims and provider databases and provides expertise On business requirements for multiple business region.

  • Identifies, analyzes, and resolves issues for multiple system provider databases.

  • Participates in system testing and analysis in support of new functionality, new System processes, and business rules changes.

  • Validates the data to be housed on provider databases and ensures adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing.

  • Researches and resolves the most complex exceptions and error reports.

  • Determines regional/cap/business indicators for multiple business areas

  • to assure accurate reimbursement based on provider contract and area fee Schedules.

  • Determines training needs and provides training to less experienced associates and outside customers on multiple provider data base systems and with multiple business requirements.

  • Obtains and loads fee schedule updates, professional & hospital contract Updates and claim check updates.

* **Manager will determine level based upon the selected applicant’s skillset relative to the qualifications listed for this position.

Business Analyst II

  • 3-4 years of experience working with Claims, Provider pricing, Benefits

  • Proficient in Office Word, Excel and Outlook is required

  • Knowledge of the WGS Mainframe systems

  • Experience writing Business/Technical Requirements

Business Analyst III

  • 5 or more Experience with WGS Pricing Systems

  • 3-4 years of experience working with Claims, Provider pricing, Benefits

  • 2 years or more experience with developing, maintain and Mixer keys to include the understanding of Local Provider networks, Employer Networks, Intra-Plan and ITS Host Business and non-par pricing

  • Proficient in Office Word, Excel and Outlook is required

  • Knowledge of the WGS Mainframe systems

  • Experience working with pricing system conversions

  • Experience writing Business/Technical Requirements

Business Consultant

  • BS/BA degree or 8 years’ experience of business analyst or system analyst

  • 3-4 years of experience working with Claims, Provider pricing, Benefits

  • 5 or more Experience with WGS Pricing Systems

  • 5 years or more experience with developing, maintain and Mixer keys to include the understanding of Local Provider networks, Employer Networks, Intra-Plan and ITS Host Business and non-par pricing

  • Proficient in Office Word, Excel and Outlook is required

  • Knowledge of the WGS Mainframe systems

  • Experience working with pricing system conversions

  • Experience writing Business/Technical Requirements

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.