SHIFT: Day Job
Responsible for financial leadership, decision support, and strategic consultation to the Ohio Medicaid Health Plan leadership team. Directs health plan financial analysis, cost of care analytics, trend analysis, financial reporting, financial operations, and cost and budget management and allocation in a Health Plan with an assigned product or portfolio, which may include specialty products and/or provider contracting arrangements that carry financial risk to the plan P&L, serves as legislative consultant with state partners on financial/reimbursement policy and payment mechanisms.
Primary duties may include, but are not limited to:
- Directs market leadership for P&L and SG&A budget; operates as a financial liaison to state partners; leads rates management and negotiation including reserve development and analytics; and leads the Medical Cost and RX Trend identification and mitigation process with key business partners including network and clinical teams.
- Maintains trends that are appropriate given premium reimbursement.
- Reviews, analyzes, reports, and presents financial results. Provides decision support for business unit President and senior management teams’ operational and business goals.
- Achieves Medical Cost and MLR targets set in plans and forecasts; may ensure that provider network contracting efforts obtain the best possible financial arrangements; may own the setting of and achievement of Cost of Care targets; and achieves operating gain targets set in budgets and forecasts.
- Directs Health Plan preparation of annual operating/capital budget and forecasts to provide senior leadership with tools necessary to maximize investment of resources.
- Directs interface with regulatory and audit personnel and technical consultants as required to ensure fiscal accountability.
- Supporting the pricing actuaries on premium rate actions.
- Representing the health plan at key state and provider meetings; oversees the processing and delivery of several major provider pass thru payments; and is a key member of the Ohio leadership team.
- Helping to support the plan president on setting and achieving health plan goals.
Requires a BS/BA in Finance, Business Administration, Economics or Accounting; 8-10 years of progressive financial experience accounting, financial reporting, business analysis, budgeting, forecasting, and strategic and tactical planning within a health insurance/managed care environment; experience with complex business environments including multiple entity and highly regulated situations; or any combination of education and experience, which would provide an equivalent background.; MBA preferred. Significant experience working with shared savings arrangements is strongly preferred. Medicaid managed care experience preferred.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.
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