Anthem, Inc. Medicaid State Operations Director in Mason, Ohio
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 benefits companies and a Fortune Top 50 Company.
The selected candidate will be supporting the Ohio Medicaid market, including implementation of new products, supporting the plan President and operations lead.
The Medicaid State Operations Director role is responsible for operations functions, including coordination between internal departments, ensuring the appropriate strategy, tactics and processes are in place to affect solid organizational operations and oversight. Primary duties may include, but are not limited to:
• Resolves programmatic challenges related to operations including member issues, provider claims issues, contract configuration issues, etc.
• Serves as liaison to Health Plan support services, which could include: Claims, Enrollment, NCC, PDM/PDQ, configuration; Quality, Regulatory Compliance, IT, Reimbursement policy, etc.
• Identifies opportunities for Operational Excellence and works to create seamless processes between shared services and the Health Plan.
• Develops and implements key operational indicators to be used for monitoring and analysis of the Health Plan operations.
• Serves as a liaison with state regulatory agencies when appropriate.
Requires a BA/BS in Business, Healthcare Administration or related field; 10 years of relevant experience including 8 years of in-depth experience in managed care operations; or any combination of education and experience, which would provide an equivalent background.
• Master’s degree preferred.
• Six Sigma Black Belt preferred.
• Medicaid and Medicare knowledge and experience strongly preferred.
• Must be financially savvy.
• Relationship building a must.
• Account management experience.
• Must be a leader.
This position is not a position with direct reports, but rather an individual contributor role.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2019 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.