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PS16277 Requisition #
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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 benefits companies and a Fortune Top 50 Company.
 
Pharmacy Service Coordinator - Specific Anthem site locations #PS16277

 

*This is not a Work at Home and is an in office only position

Summary: The primary objective of this role is to support issue resolution for pharmacy UM commercial business. Duties and responsibilities will be related to this line of business. Some examples of this work would include; responsible for being the primary contact and liaison for and between the company's medical partners and the pharmacy UM department for trouble shooting along with implementing and de-implementing client’s drug benefits.

Primary duties may include, but are not limited to: 
  • Researches and interprets claims issues while ensuring good, accurate and timely customer service for our Ingenio clients. 
  • Understands the intricacies of prescription drug benefits and how they adjudicate on the medical and pharmacy claims platforms. 
  • Coordinates, conducts and/or supports internal and external client meetings or training sessions as needed. 
  • Works with multiple departments and sources in order to accommodate the needs of our clients; for example - claim processing, customer service, & medical account management. 
  • Oversees benefit set up process to ensure product changes occur with minimal disruption. 
  • Develops, reviews, and researches capabilities of prior authorization system to accommodate drug benefit design requested by clients or suggested by medical teams. This includes attendance and support for processes to review new plan design requests, i.e. Customer Exception Process and National Accounts Approval Process, and collaborating with Product development, Proposal Development, Customer Exception and Sales Departments. 
  • Create or coordinate the delivery of standard and custom reports for internal and external clients, such as claims, drug utilization and impact reports to our clients in compliance with performance guarantees and client requests. 
  • Assists the AE in all things client related. Responsible for the day to day inquiries about cases, KPI’s and simple reporting. Serve as the client “help desk”. 

 
  • Requires a BA/BS degree; minimum 5 years of customer service, claims, and/or membership experience in healthcare; minimum 3 years related pharmacy experience with working knowledge of pharmacy benefit management industry and medical benefit design;  or any equivalent combination of education and experience, which would provide an equivalent background.
  • Pharmacy Tech experience preferred. 

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.


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Health Care Analytics

The Health Care Analytics (HCA) team focuses on transforming the way data is used within the health care industry. They provide strategic analysis that impacts business decisions, improves efficiency and drives innovation.

As we expand our technology and analytics capabilities, we are searching for associates that have a passion for analytics and the drive to pave the way in a growing industry.

Career opportunities are available in the following areas:

  • Strategy and planning: Ensures strategic alignment between HCA projects and the organization's broader goals. Also integrates analytics strategy into the execution process, including program management, project controls, communications and vendor oversight.
  • Operations: This department houses the HCA shared-services functions including project financial controls and estimations, demand management, user acceptance testing, and coordination and release management.
  • Customer management analytics: Provides accurate, timely and reliable delivery of client reports, which include data analyses, insights and other information that demonstrates Anthem’s value as a business partner.
  • Financial management analytics: Works closely with HCA leaders and other Anthem management to provide support to the finance and accounting teams through financial reporting systems.
  • Member management analytics: This team is responsible for the risk adjustment program and analytics, the member management program, predictive analytics and member management analytic products management.
  • Provider management analytics: Manages Anthem’s unit cost trend, provider contract modeling, network profiling, payment innovation analytic solutions, and other analytics that enable provider collaboration strategies.
  • Research, development and transformational analytics: Works with senior leaders to manage implementations, new product development and provides acquisition support.

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