Anthem, Inc. Provider Experience Manager Senior in La Mirada, California
SHIFT: Day Job
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.
• Responsible for providing quality, accessible and comprehensive service to the company's provider community. • Develops and maintains positive provider relationships with provider community by regular on-site and/or virtual/digital visits, 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. • Is assigned Hospitals/Facilities and/or National Ancillary provider groups. • Functions as a high-level technical resource to resolve or facilitate complex provider issues. • Coordinates Joint Operation Committees (JOC) of hospital/facility and/or National Ancillary provider groups, driving the meetings in the discussion of issues and changes. • Aids 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. • Organizes and executes external Provider Townhalls/Seminars. • Researches issues that may impact future provider negotiations or jeopardize network retention. • May be responsible for monitoring department metrics, provider assignments and oversight of daily activities and provide feedback to manager on performance management, day-to-day training, guidance, and workflow of Provider Experience Consultants and Provider Experience Managers. • Travel up to 25%.
The health and safety of our associates, members and communities is a top priority for Anthem. This priority has become increasingly important as we continue to face the challenges of the COVID-19 pandemic. Anthem believes vaccination is the best way to reduce the spread of COVID-19 and protect our members, associates and communities. To minimize the risk of transmission of the COVID-19 virus and maintain a safe and healthy workplace to safely serve our members, vaccination may be required for specific roles. (At Anthem, fully vaccinated means it has been at least two weeks since you have received the second dose of a two-dose vaccine such as Moderna or Pfizer, or the single dose of a single dose vaccine, such as Johnson & Johnson). Accommodations for medical and sincerely held religious reason for not being vaccinated, consistent with applicable law, Anthem will be considered for reasonable accommodation on this basis. Anthem continues to monitor the pandemic following all CDC guidelines, federal, state and local laws. Policies continue to be adjusted as new information emerges.
• Requires a bachelor’s degree • 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.
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.