Anthem Inc. Medical Jobs

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Anthem, Inc. Performance Quality Auditor I/II in Atlanta, Georgia

Description

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 benefits companies and a Fortune Top 50 Company.

Location: Roanoke, VA; Denver, CO; Atlanta, GA; Indianapolis, IN; OPW;

Responsible for evaluating the quality of services and interactions provided by organizations within the enterprise. Included are processes related to enrollment and billing and claims processing, as well as customer service written and verbal inquiries.

Performance Quality Auditor I

Primary duties may include, but are not limited to:

  • Evaluates the quality and accuracy of transactions and/or communications with providers, groups, and/or policyholders.

  • Identifies, documents, and reports any transaction errors or communications issues in a timely manner to ensure prompt resolution.

  • Tracks and trends audit results, providing feedback to management.

  • Identifies and reports on systemic issues which create ongoing quality concerns.

  • Generates monthly reports of audit findings, supports clients with issues identified and develops reports to assist management with information requested. Produces other ad hoc reports as requested by internal and/or external clients.

  • Associates at this level conduct routine audits, generally related to a single function on a single systems platform for a single line of business.

Performance Quality Auditor II

Primary duties may include, but are not limited to:

  • Evaluates the quality and accuracy of transactions and/or communications with providers, groups, and/or policyholders.

  • Identifies, documents, and reports any transaction errors or communications issues in a timely manner to ensure prompt resolution.

  • Tracks and trends audit results, providing feedback to management.

  • Identifies and reports on systemic issues which create ongoing quality concerns.

  • Generates monthly reports of audit findings, supports clients with issues identified and develops reports to assist management with information requested.

  • Produces other ad hoc reports as requested by internal and external clients. Associates at this level conduct routine to complex audits, generally related to one or more functions on one or more systems platform for one or more lines of business.

Qualifications

Performance Quality Auditor I

Requires high school diploma or equivalent (GED); 2 years experience with the company in an enrollment and billing, claims and/or customer contact automated environment (preferably in healthcare or insurance sector); working knowledge of insurance industry and medical terminology; working knowledge of relevant systems and proven understanding of processing principles, techniques and guidelines; ability to acquire and perform progressively more complex skills and tasks in a production environment or any combination of education and experience, which would provide an equivalent background.

Performance Quality Auditor II

Requires high school diploma or equivalent(GED); 3 years experience including a minimum of 1 year related experience in a quality audit capacity (preferably in healthcare or insurance sector) with consistent above target performance; working knowledge of insurance industry and medical terminology; detailed knowledge of relevant systems and proven understanding of processing principles, techniques and guidelines; and ability to acquire and perform progressively more complex skills and tasks in a production environment or any combination of education and experience which would provide an equivalent background.

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.

REQNUMBER: PS41943-Atlanta-Atlanta

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