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Anthem, Inc. Medical Policy Analyst Sr in Midland, Georgia


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: Remote Based

The Medical Policy Analyst, Sr is responsible for researching and drafting evidence-based strategies and interventions that target health related social needs (HRSN), including health equity, with the goal of improving health outcomes, reducing avoidable utilization of costly health services, and improving health equity. Supports the development of Corporate Medical Policy ensuring the use of valid and consistent research methodologies.

Primary duties may include, but are not limited to:

  • Develops and maintains a library of evidence-based interventions that target HRSN and community health (HRSN/CH).

  • Provides rapid response evidentiary assessments of public and community health related issues identified through any channel including but not limited to media inquiries, executive inquiries, sales/product management inquiries, new publications, or new drug/device approvals.

  • Conducts structured research within defined methodologies.

  • Drafts and modifies policies using consistent template, tools and criteria.

  • Reviews new and updated codes for accuracy and consistency.

  • Researches relevant studies and reviews articles for development of local medical review policies and for responses to inquiries from providers.

  • Works with Medical Directors on development of local medical review policies.

  • Finalizes issues and ensures implementation of these policies.

  • Responds to internal and external requests that seek written clarification of a general or specific policy question. The response may be reiteration of an established policy, a redefinition of the current policy, or research to determine a new or revised policy.


Minimum Requirements:

  • Requires a BA/BS in a related field;

  • 5 years of related experience; or any combination of education and experience, which would provide an equivalent background.

  • Limited travel may be required

    Preferred Qualifications:

  • Experience in health-related social needs and disparities in equity and inclusion issues is highly preferred.

  • Nursing degree or MPH preferred.

  • Clinical research experience preferred.

  • Working knowledge of coding 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. 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 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.

REQNUMBER: PS61338-Georgia