Anthem Healthcare Economincs Consultant (Prov Contract/CofC Consult) - (WI preferred) - 131437 in Gilroy, California

/ 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.

  • Prov Contract/Cost of Care Consultant *
  • Job Summary: *

    This Provider Contract/Cost of Care Consultant level, will be responsible for reporting and analysis for Commercial Healthcare Insurance programs for a given Health Plan, providing all analytical needs. The successful candidate will create and interpret reports, develop ad hoc reporting and drill down analytics to support medical cost management, including identification of Medical Cost trend drivers, identification of provider billing and payment anomalies and outlier providers, identification of potential fraud, waste and abuse, identification of overpayments, support of clinical medical management process improvements and creation of actionable analytics which facilitate the development of Cost of Care savings initiatives. The role also includes presentation of results and analytics to Plan leaders, both individually and in workgroup or team meetings and to Corporate functional leadership. Strong relationship with Plan Leadership, Commercial Healthcare Economics and Finance and Actuarial.

  • Primary duties may include, but are not limited to: *

    • Provides financial support in the analysis of medical expenses, medical expense trend, membership, revenue, medical loss ratio and drill downs.

    • Provides analysis of revenue and medical costs on a restated basis and/or paid basis to facilitate identification of actionable trend drivers and cost of care initiative

    • Provides analysis of Clinical data to support process improvements leading to Cost of Care savings.

    • Independently develops sound applications and models necessary to efficiently measure, understand, monitor and explain the plan’s medical cost structure and restated financial results.

    • Proactively identifies medical expense trend opportunities and risks throughout the plan such as trend anomalies, outliers, behaviors etc.

    • Utilizes all available tools and applications to facilitate the development of actionable information to create performance improvement

    • Completes the most diverse and complicated projects and performs complex analytical studies.

    • Prepares comprehensive documented observations, analyses and interpretations of results including technical reports, summaries and quantitative analyses.

    • Present medical cost trends to a wide audience on a regular basis.

    • Consults with Plan leadership, including P&L, Segment, Provider Contracting, Clinical, Claims Processing and Finance on analyses and recommendations regarding appropriate courses of actions. Other key competencies:

    • Leadership, communication and presentation skills.

    • Trust-building: Honor your word by doing what you say you are going to do.

    • Implementation/Execution: Good at organizing and managing multiple priorities and/or projects by using appropriate methodologies and tools.

    • Innovative: Introduce new ideas and processes which improve performance and productivity.

    • Team player.

    • Willing to learn; and a quick learner.

    • Problem-solving: Solve problems with the ability to encourage others in collaborative problem solving. Act as both a broker and consultant regarding resources; engage others in problem solving without taking over.

/ Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2016 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran. /

  • Qualifications for Provider Contract /Cost of Care Consultant *

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

    • 5 years’ experience in broad-based analytical, managed care payor or provider environment.

    • Considerable experience in statistical analysis and healthcare modeling.

    • Any combination of education and experience, which would provide an equivalent background.

    • Master's degree preferred.

    • Progressive data analysis and reporting experience.

    • Proficiency with Microsoft Excel and VBA.

    • 3 years of experience in managed healthcare analytics is strongly preferred.

    • 3 years of experience in Medicaid or Medicare is preferred.

    • SQL experience is required.

    • Advanced Excel knowledge is required.

    • Familiarity with claims data and authorization data experience preferred.

    • SAS experience preferred.

Job Reporting & Data Analysis

Title: Healthcare Economincs Consultant (Prov Contract/CofC Consult) - (WI preferred) - 131437

Location: california-Gilroy

Other Locations: Wisconsin

Requisition ID: 131437