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.
Business Consultant Sr - PS16403Location(s): Mason, OH; Atlanta, GA; St. Louis, MO; Las Vegas, NV; Virginia Beach, VA; Morristown, NJ; Chicago, IL; Minneapolis, MN; Louisville, KY; Wallingford, CT
The Business Consultant Sr is responsible for validating highly complex and varied business needs and pharmacy benefit designs including clinical edits and prior authorizations being applied accurately. These needs typically involve a significant expenditure or cost savings and impact a wide range of functions. Also, provides expertise to lower leveled consultants. This is the highest level in a career progression.
Primary duties may include, but are not limited to:
- Review the clients’ benefits, ensure their intent was correctly communicated for administration, validate the benefits were accurately set up in the processing system.
- Knowledge of Prior Authorization processing and clinical edits.
- Investigate issues, ensuring correction and timely and accurate identification of any impact.
- Provides expertise to lower level consultants on the analysis of business needs to determine optimal means of meeting those needs.
- Determines specific business application software requirements to address the most highly complex and varied business needs.
- May lead teams of analysts assigned to the most complex projects, typically those of highest importance and impact to the way in which we do business.
- Analyzes and designs solutions to address varied and highly complex business needs.
- Requires a BS/BA degree,
- 10 + years of business analysis experience, which should include analysis, project management, working knowledge of pharmacy benefits designs, prior authorization processing;
- 3 + years’ experience as a Business Consultant with project management skills; or any combination of education and experience, which would provide an equivalent background.
- Ability to communicate with senior leaders across the Pharmacy organization, and document and present complex issues and solutions.
- Experience managing complex client issues.
- Ability to travelrequired (10%).
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for DiversityAn Equal Opportunity Employer/Disability/Veteran.
PS16403 Requisition #