Anthem, Inc. External Performance Audit Coordinator in Portland, Maine
SHIFT: Day Job
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.
Responsible for conducting and coordinating external and internal quality performance audits which are administered based on mandatory guidelines published by the BCBSA.
Primary duties may include, but are not limited to:
Leads projects related to the coordination of performance audit reviews with agencies external to Anthem.
Reviews, evaluates and verifies the quality of claims adjudication, enrollment processing and customer service transactions.
Renders non-biased and ethical decisions while assuring BCBSA guidelines are adhered to the fullest extent.
Performs in-house training as needed.
Compiles and reports audit results to internal corporate management, executive management, Operations areas, Sales and Marketing, Interprocess Quality Assurance coordinators and other outside groups as required.
Validates sampling methodology and contents of data reports.
The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against Covid-19. All offers of employment are conditioned on completion of a background check, including COVID-19 vaccination verification. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.
Requires B.A. or B.S. degree; 3 years auditing experience, or any combination of education and experience, which would provide an equivalent background.
Must demonstrate knowledge of regulations related to specialized functions.
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.