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Anthem, Inc. Medical Policy Consultant in Wilmington, Delaware


SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At National Government Services (NGS), an independent subsidiary of Anthem, Inc. and one of the largest Medicare contractors in the country, it’s a powerful combination. It’s 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.

Responsible for researching and drafting NGS Medical Policy ensuring the use of valid and consistent research methodologies.

Primary duties may include but are not limited to:

  • 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.

  • Research relevant studies and reviews articles for development of local coverage determinations coverage articles and coding guidelines and for responses to inquiries from providers.

  • Works with Medical Directors on development of local coverage determinations.

  • Finalizes issues and ensures implementation of these policies.

  • Works with other internal areas and with the Medical Directors to respond 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 Qualifications :

  • Requires a BA/BS degree in a related field and a minimum of 2 years related experience; or any combination of education and experience which would provide an equivalent background.

  • Travel may be required.

  • Working knowledge of coding required.

    Preferred Qualifications:

  • Prior medical literature research experience or related experience preferred.

  • Technical writing experience preferred.

  • MPH with research background beneficial.

  • Medicare experience 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. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. 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 Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact for assistance.

    REQNUMBER: PS64970-Wilmington-Wilmington