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Director II Medicare Operations

Company: Anthem, Inc.
Location: Miami
Posted on: September 16, 2020

Job Description:

Welcome to the Anthem Careers site! We have been hard at work to improve our job search and application systems to better serve you. It is now easier to find and apply for relevant jobs as well stay connected with Anthem. Here are a few of the updates you may notice:

No more profiles! We no longer require you to create a log in and password to apply for a job and you won't be able to access previously created profiles, but don’t worry – we still have your previous application(s) on file. Due to technical difficulties currently being resolved, the ‘Track Your Job Application Status’ functionality is not available.

Job Alerts – If you had previously registered to receive job alerts and wish to continue to receive these notifications, please re-register by clicking the “job alert” button.

NEW! Didn’t find a job that is right for you? Join a Talent Network to stay informed on news and job opportunities with the Anthem Team!

It is important that you apply using an email address which is unique to you and not shared with a friend, relative, spouse, or significant other. Our recruiting system uses your email address as your unique identifier. If you apply with a shared email address, your application will overwrite any previous applicant record with the same email address. Additionally, please ensure that you use a valid email address, free from typos, as there are a variety of communications which may be sent to the email address with which you apply

Director II Medicare Operations (PS36933) Your Talent. OurVision . At Anthem, Inc., it’s a powerful combination, and the foundationupon which we’re creating greater access to care for our members, greater valuefor our customers, and greater health for our communities. Join us and togetherwe will drive the future of health care.

This is an exceptional opportunity to do innovative workthat means more to you and those we serve at one of America's leading healthbenefits companies and a Fortune Top 50 Company.

Work Location - Office based:  Coconut Grove, FL

Responsible fordirecting multiple business function operations teams with primaryresponsibility for but is not limited to: Claims, Medical Policy/Review,Grievance & Appeals, Overpayment Recoveries, and System Configuration. Primaryduties may include, but are not limited to:

Responsiblefor Part A/B Claims processing, pre-pay and post-pay medical review activities,development and reconsideration of medical review policies for Part A/B; andthe analysis of data to review the impact of medical policy application as wellascertain adherence to the policies.

Directs theactivities of all Part A, B, and DME re-determinations; Administrative LawJudge (ALJ) appeals; clerical error re-openings; and the investigation andrecoupment of all claim overpayments and subrogation of those claims whereMedicare should be the secondary payer.

Responsiblefor data mining & reporting, identifying opportunities for improvement andconsistency of decisions, and the CMS quality and timeliness standards.

Responsiblefor System Configuration for both benefit and payment configuration.

Drivesinnovation throughout the assigned business function areas to reduce theoverall costs associated with performing the CMS requirements.

Participatesin leadership forums and reports on operational updates as needed.

Hires, trains,coaches, counsels, and evaluates performance of direct reports.

Requires a BA/BS in a related field; 10 years of professional/leadership experience with CMSincluding areas such as operations, claims, configuration strategic planning,project management, Medicare or related healthcare insurance or medical policyfield, 3- 5 years of management experience; or any combination of education andexperience, which would provide an equivalent background. Moderate travel isrequired.

Anthem, Inc. is ranked as one of America’sMost Admired Companies among health insurers by Fortune magazine and is a 2019DiversityInc magazine Top 50 Company for Diversity. To learn more about ourcompany and apply, please visit us at careers.antheminc.com. An EqualOpportunity Employer/Disability/Veteran.

Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem. Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem.

EEO is the Law Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.

Anthem, Inc. is committed to helping individuals with disabilities participate in the workforce and ensuring equal opportunity to apply and compete for jobs. If you are an individual with a disability and require a reasonable accommodation to complete the application process, please email Human Resources at ability@icareerhelp.com for further assistance.

*WARNING : Please beware of phishing scams that solicit interviews or promote work-at-home opportunities, some of which may pose as legitimate companies. Please be advised that Anthem will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission here by selecting the ‘Rip-offs and Imposter Scams’ option. Anthem requires a completed online application for consideration of employment for any position.

Keywords: Anthem, Inc., Miami , Director II Medicare Operations, Other , Miami, Florida

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