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 – Columbia, SC (HYBRID)

Provider Experience Mgr
•    Act as the primary point of contact for Provider Outreach team and facilitates contact with Anthem shared services as required
•    Responsible for providing quality, accessible and comprehensive service to the company's provider community. 
•    Develops and maintains positive provider relationships with provider community by communicating administrative and programmatic changes, and facilitating, education and the resolution of provider issues. 
•    Serves as a knowledge and resource expert regarding the most complex provider issues impacting provider satisfaction; researches and resolves the most complex provider issues and appeals for prompt resolution. 
•    Works with internal matrix partners to triage issues and submit work requests. 
•    Functions as a high level technical resource to resolve or facilitate complex provider issues. 
•    Provides assistance regarding Annual Provider Satisfaction Surveys and required corrective action plan implementation and monitoring, education, contract questions and non-routine claim issues. 
•    Coordinates communications process on such issues as administrative and medical policy, reimbursement and provider utilization patterns. 
•    Coordinates Provider Manual updates/maintenance. 
•    Coordinates prompt claims resolution through direct contact with providers, claims, pricing and medical management department. 
•    Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery. 
•    Researches issues that may impact future provider negotiations or jeopardize network retention. 
 

Qualifications

Minimum Qualifications:
•    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 a Bachelor's degree and a minimum of 5 years of customer service experience including 2 years of experience as a Network Management Rep; or any combination of education and experience, which would provide an equivalent background. 
•    Travel may be required.

Preferred Qualifications:
•    Prior project management experience over 1 year is highly preferred
•    Prior experience working with provider community is highly preferred
•    Strong understanding of claims processing is preferred
•    Prior experience and strong understanding of Medicaid and Managed care is preferred
•    Knowledge WGS application is a plus

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.