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PS13259 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.

Mgr Performance Audit - St. Louis, MO locations preferred (PS13259)

Summary: Responsible for directing performance audit activities for areas that may include multi-function, multi-system, multi-states, or multiple business units to ensure performance meets or exceeds levels required for continued licensing and service mark use. 

Essential duties to include, but are not limited to: 
  • Reports service performance to applicable regulatory or oversight agencies and multiple levels of internal management. 
  • Ensures that audit scope and auditors follow applicable guidelines for sampling, auditing and reporting performance. 
  • Implements applicable audit and reporting guidelines. 
  • May direct and monitor performance guarantee implementation, processes, reporting and performance improvement. 
  • Establishes and coordinates compliance plan activities within the Business Unit.  
  • Manages operations performance audits of claims, adjustments and related processes. 
  • Leads auditors to analyze trends and initiate corrective action with appropriate operating areas. 
  • Hires, trains, coaches, counsels, and evaluates performance of associates.

  • BA/BS, or equivalent combination of experience and education required and a minimum of 5 years experience in related area, preferably internal or public audit, quality assurance and project management. 
  • Certifications desired.  
  • Extensive knowledge of health claims processing systems, policies and procedures required.  
  • Ability to analyze and interpret policy, contracts, statistical data and government regulations required .  
  • Must be able to organize efficient work flows and very high levels of accuracy.  
  • Computer skills to include word processing and spreadsheet software. 
  • Leadership and management skills. 
  • Pharmacy Benefits Manager (PBM) experience strongly preferred. 
  • Analytical and problem solving skills. 
  • Healthcare experience strongly preferred. 
  • Strong oral and written communication skills.
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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As one of America’s largest health benefits companies, we at Anthem have a profound appreciation for service. Our organization proudly supports our nation’s active, reserve and veteran military service members and their spouses.

This is an exciting opportunity to advance your life and career, while still protecting and serving others. Come see for yourself why Anthem is recognized as a Top Employer by GI Jobs and among the “Best of the Best: Top Veteran Friendly Companies” by US Veterans Magazine.

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