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QM Member Liaison Sr - Pewauk...


Job Summary

Pewaukee, WI
Other/Not Classified
Job Type
Full Time
Career Level
Experienced (Non-Manager)
Job Reference Code

QM Member Liaison Sr - Pewaukee, WI - 137444

About the Job

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.
The QM Member Liaison Sr. is responsible for developing, coordinating, and implementing member advocacy initiatives within the health plan as well as member retention by investigating and leading the resolution of member complaints. Coordinates the member advocacy program throughout the functional areas of the health plan. Primary duties may include, but are not limited to: Investigates, resolves, and documents member complaints in accordance with policies and state requirements. Implements comprehensive Member Advocacy Program to meet the needs members. Investigates and resolves issues regarding members with non-compliant, behavioral, or abusive conduct with providers. Identifies and submits updates upon receipt of any regulatory updates or changes. Collaborates with local consumer advocacy groups to gain insight regarding the special health care needs of Medicaid enrollees. Tracks, trends, and reports quality and access complaints; coordinates and documents follow-up actions. Serves as a liaison with state hot line staff and internal compliance personnel.

Requires a BA/BS in HealthCare or related field; 5 years of experience in a social or health related service-oriented industry; or any combination of education and experience, which would provide an equivalent background.

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.



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