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Anthem, Inc. Provider Contract/Cost of Care Consultant Senior in Upland, California


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.

Provider Contact Cost of Care Consultant Senior

This position is located in California

The Provider Contact Cost of Care Consultant Senior p rovides the highest level of analytical support to the Cost of Care and/or Provider Contracting organizations. Focuses efforts on lowering claims costs, improving the quality of care, and increasing member and provider network satisfaction. Provides expert advice, analytic and consultative support to Medical Directors and management on cost of care issues. Leads large-scale initiatives with high dollar, cost savings opportunities. Partners with provider contractors to develop contracting strategy and supports all aspects of the contract negotiation process. Works with multiple provider types including the most complex, high profile providers. Supports a full range of contract arrangements and pricing mechanisms including the most complex contract terms. Works on the most complex, large-scale enterprise wide initiatives and acts as project lead. Acts as a strategic partner to management. Primary duties may include, but are not limited to:

  • Uses analytic tools to: track both health risks and compliance, as well as supporting the contract negotiation process.

  • Types of analyses include performing sophisticated retrospective data analytics; developing the most complex new models and modifies existing models to create predictive impact decision making tools; performing healthcare cost analysis to identify strategies to control costs; projecting cost increases in medical services by using analytic techniques for PMPM trending via multiple variable analysis; preparing complex pre-negotiation analyses to support development of defensible pricing strategies; performing modeling to compare various contract scenarios based on member utilization patterns and 'what if'; measuring and evaluating the cost impact of various negotiation; researching the financial profitability/stability and competitive environment of providers to determine impact of proposed rates; and projects different cost of savings targets based upon various analytics.

  • Identifies cost of care savings opportunities by analyzing practice patterns in relation to office visits, referral practices, and specialty care procedures and recommends policy changes and claim's system changes to pursue cost savings.

  • Reviews results post-implementation to ensure projected cost savings are realized and recommends modifications as applicable.

  • Recommends standardized practices to optimize cost of care.

  • Educates provider contractors on contracting analytics from a financial impact perspective.

  • May recommend alternative contract language and may go on-site to provider premises during contract negotiations.

  • Researches provider's financial profitability/stability and competitive environment to determine impact of proposed rates.

  • Communicates fee strategies to manage provider expectations. Provides on-going analytic and consultative support during complex and the most intense provider negotiations.

  • Educates provider contractors on contracting analytics from a financial impact perspective.

  • May recommend alternative contract language.

  • May go on-site to provider premises during contract negotiations.

  • Acts as a source of direction, training and guidance for less experienced staff.

  • Looks for continuous quality improvements and finds better ways to accomplish end-results.

  • Works side by side with their manager.


Minimum Requirements

  • Requires BA/BS degree in Mathematics, Statistics or related field

  • Minimum of 7 years’ experience in broad-based analytical, managed care payor or provider environment as well as in depth experience in statistical analysis and modeling; or any combination of education and experience which would provide an equivalent background.

    Preferred Qualifications

  • Experience providing leadership in evaluating and analyzing complex initiatives strongly preferred.

  • Master's degree preferred.

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.

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. 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. 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 Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact for assistance.