Anthem Regulatory Oversight Consultant PS5734 in Roanoke, Virginia

Regulatory Oversight Consultant PS5734

Location: Denver, Colorado, United States

Field: Fraud

Requisition #: PS5734

Post Date: May 09, 2018

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.

Location: Denver, Colorado preferred but open to other Anthem offices.

The Regulatory Oversight Consultant is responsible for providing enterprise-wide reporting and oversight of federal and state regulatory implementation, compliance and exam activities. This is an experienced associate with knowledge specific to the company who can handle complex assignments or projects.

Primary duties may include, but are not limited to:

  • Serves as liaison to state Medicaid agency.

  • Builds effective working relationships.

  • Collaborates with state Medicaid agency with respect to contract and program changes.

  • Serves as internal subject matter expert with respect to state Medicaid program requirements, applicable laws and regulations, and state contracts.

  • Communicates state and federal laws and regulations throughout the company.

  • Assists with the identification of business owners to lead implementation efforts and subject matter experts to participate on project teams; provides enterprise-wide reporting on implementation status and compliance concerns.

  • Provides oversight of the regulatory process by supporting and providing expertise to corporate-wide projects and monitoring the development of implementation plans, gap analysis, milestone dates, and other significant aspects of corporate-wide projects.

  • Provides guidance to and works collaboratively with compliance areas, Legal, IT, Planning and Project Execution Units, and the Enterprise Portfolio Management Office to identify and implement improvements in the company's regulatory process.

  • Participates in enterprise-wide efforts to improve responsiveness to and consistency of company responses to market conduct exams; and provides enterprise-wide reporting on exam status, penalties and trends.

  • Obtains and maintains an awareness of industry regulatory trends, organizational developments, and company strategies that could impact the success of regulatory projects.

  • Extracts, analyzes, and reports regulatory data develops and produces standard, customized and ad-hoc reports and enhances reporting functionality.

  • Serves as a database subject matter expert and performs administrative duties related to the company's regulatory database. Maintains knowledge of database design, data definitions, system capabilities, and data integrity issues.

  • Develops and/or modifies requirements, business design specifications, user training and documentation.

  • Researches and documents business issues, translates business requirements to technical staff/vendor to ensure that requirements are incorporated into system design.

  • Tests and documents solutions while serving as the liaison between users of the tool and technical staff/vendor.

Requires a BA/BS degree, 3-5 years of responsible and effective regulatory or compliance related experience in healthcare or managed care industry that includes data analysis, reporting, research, problem-solving and project management experience; or any combination of education and experience, which would provide an equivalent background. Ability to travel may be required.

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 EOE. M/F/Disability/Veteran.