Anthem Account Service Coordinator/Manager - Remote - 139758 in Las Vegas, Nevada
/Your Talent. Our Vision/. AtAnthem, 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 willdrive 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.
_Account Service Coordinator/Manager - Remote - 139758_
Please Note: This position may be filled at either of the posted levels. The Manager will determine the level based upon the selected applicant’s skillset relative to the qualifications listed for this position.
_ _ This position is responsible for providing advanced customer service representation for Pharmacy Medicaid Operations. Partners with Pharmacy Medicaid account team, Health Plans and Government Business teams to ensure operational excellence in meeting state contractual requirements.
Primary duties may include, but are not limited to: * Directs/manages administration of contractual requirements and obligations * Coordinates as the Pharmacy Medicaid Operations SME/internal partners to ensure smooth delivery of services in accordance with contractual requirements and obligations * Interfaces with Health Plans, States, PBM, providers, and members * Work with multiple departments to make sure member needs are met for more complex issues; this includes claim processing, customer service, and account management. Other departments that one will interface with will include IT, analytics, membership, benefits. * Makes recommendations for improvements to meet customers’ expectations * Reviews reject rules, PA rejections/denials, coordination of benefits, as needed to ensure accurate and timely claim adjudication. Identify trends that need attention and resolution to prevent future issues. * Develops implementation processes and manages reporting processes to meet client retention/need and high levels of account satisfaction * Responsible for being a contact and liaison for and between the Anthem Medicaid Health Plan and the PBM to assist in implementing and de-implementing client Rx benefits. * Be acclimated to Plan designs, benefits, clinical set up, operational details, as well as processes of the accounts * Provides both on-site and off-site customer service, which may include interpreting plan design, researching/resolving phone and written inquiries, resolving claims, benefit and enrollment issues * Provides pharmacy expertise and leadership for new business launches, ACA expansions, and RFP detail regarding new/existing business opportunities
- Requires a BA/BS;
- Requires 3 years related experience, which MUST include claims, customer service and/or membership experience in healthcare; or any combination of education and experience, which would provide an equivalent background.
- Experience in pharmacy is required.
- Must have managed care experience.
- Experience with interpreting and supporting plan benefit design is preferred.
- Account management experience preferred.
- Sales license may be required.
- Travel required - Makes routine account visits
- Medicaid knowledge/experience preferred. // /Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 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.__/
Equal Employment Opportunity Statement Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.
Title: Account Service Coordinator/Manager - Remote - 139758
Location: nevada-Las Vegas
Requisition ID: 139758