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 as a contractor at Anthem (via BC Forward) that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.

Responsible for identifying business needs and translates the needs into application software requirements in support of operations, productions and projects.

Primary duties may include, but are not limited to:

• Designs and builds new standard and non-standard benefit plans, reviews and analyze benefit summaries; and identifies best approach to code/develop benefits to achieve optimum adjudication levels.
• Maintains avoidance to negative financial, regulatory, and operational impact.
• Performs testing and quality assurance of product developed.
• Research and analysis of RFP proposals, small product enhancements and product projects.
• Create and maintain issue log on appropriate tool, resolve defects based on knowledge and analysis of system functionality.
• Researches and responds to inquiries from various departments.
• Must be able to perform all duties of lower level positions as directed by management.
• Demonstrates ability to configure benefit, understanding client requirements, i.e., SOB (Summary of benefits), Account Structure, eCEM.
• Ability to thrive with multiple, complex and timeline driven work efforts.
• Ability to professionally interact with internal and external teams and vendors.
• Self-motivated and work independently without prompt or follow-up.
• Ability to facilitate and resolve issues amongst multiple internal and external teams until issue resolution and implementation.
• Understand the urgency of the business and how that translates to personal work ethic and a positive, seamless member experience.
• Highly organized with attention to detail.
• Collaboratively identifies areas of pharmacy improvement with other departments to ensure plan build accuracy.
• Serves as a subject matter expert on pharmacy benefits and pharmacy coding system set-up.
• Other tools used daily include Adobe viewer, Word, Outlook, PowerPoint, SharePoint, MS Teams, Webex, and occasionally Visio.

Requirements:

• High School diploma or GED; up to 3 years experience in claims processing, previous medical health care or analytical experience;
• 3-5 years benefit coding experience; or any combination of education and experience that would provide an equivalent background.
• BA/BS degree preferred.
• Pharmacy Spider and Benefit Builder coding experience preferred.
• Pharmacy benefit experience preferred.
• PBM experience preferred.
• Experience with Salesforce.com and JIRA & Salesforce.com preferred.
• Experience with Microsoft Excel required.

Additional Details:

• Work Schedule: Eastern time preferred, standard business hours
• Ability to work extended hours, weekends, and/or holidays according to business needs

An Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.

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