Anthem Mgr. I Investigations - PS4161 in Santa Ana, California

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: Preferred location is 5800 Northampton Boulevard, Norfolk, VA 23502 Working anywhere within the US remote is an option

_Mgr. I Investigations_ Manager I, Investigations for Concept Development Team within Enterprise Provider Education. Position will manage a team of certified professional coders in developing provider education concepts supporting CoC goals. Primary duties may include, but are not limited to: * Coordinates the analysis of provider utilization patterns and trends and of provider billing and financial data and manages the concept inventory.. * Coordinates the review of concepts to ensure validity and applicability of data to ensure correct outlier identification. * Keeps abreast of changes in benefits, policies and regulations and in CMS performance standards and assists management in the interpretation of policies and procedures across all lines of business. * Hires, trains, coaches, counsels, and evaluates performance of direct reports. * Prioritizes/manages the Concept Development Team’s workload. * Identifies and prioritizes solutions which generate the greatest CoC return. * Become knowledgeable of the business goals, processes, and improvement opportunities. * Attention to detail is crucial.


  • Requires BA/BS
  • 5 years in investigations ; or any combination of education and experience, which would provide an equivalent background.
  • The Government requires that personnel working on Medicare Fraud investigations are U.S. Citizens.
  • Requires CPC certification
  • Prior Management experience a plus

Job Fraud

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: Mgr. I Investigations - PS4161

Location: california-Santa Ana

Other Locations: VA-Norfolk

Requisition ID: PS4161