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Business Consultant-PS35321

Job Family: Business Support
Req #: PS35321
Date Posted: Jul 31, 2020


SHIFT: Day Job

SCHEDULE: Full-time

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 Claims Payment Integrity is seeking new and innovative methods to identify recovery opportunities using machine learning models. The Business Consultant  position will be responsible for translating complex and varied business needs into business cases or business requirements documents (BRD) to create machine learning models or data mining queries that will contribute to cost of care savings.Primary duties may include, but are not limited to:

  • Partnering closely with data scientists, query developers and business owners to in the execution of machine learning models by providing feedback during various phases. 
  • Managing and prioritizing work assignments based on business needs.
  • Provide direction and guidance to team members and serves as an expert for the team. 
  • Identify process improvement opportunities that result in increased savings.
  • Serve as a liaison between the data science, recovery adjustments and other business partners.
  • Identifying automation opportunities.
  • Consults with business partners concerning processes, procedures, contracts, processing rules and other system rules. 
  • Determines specific business application software requirements to address complex and varied business needs.
  • Analyzes and designs solutions to address complex and varied business needs.
  • Consults with business partners concerning application and implementation of technology.
  • Responsible for translating the most highly complex and varied business needs into application software requirements.
  • These needs typically involve a significant expenditure or cost savings and impact a wide range of functions.Analyzes and designs solutions to address varied and highly complex business needs. 


  • BS/BA degree preferred 8-10 years of related experience, which should include recovery, analysis, audit, project management, WGS claims processing experience, management skills; or any combination of education and experience, which would provide an equivalent background.
  • Ability to manage multiple models and projects in various stages to completion.
  • Experience with commercial claims across the enterprise.


 Must possess:

  • Strong analytical and problem solving skills with research oriented approach.
  • Strong written, verbal and interpersonal communication skills required.
  • Advanced skill level with MS Excel; pivot tables, formulas, V-lookup, etc.
  • Strategic thinking and collaboration skills.


Preferred skills:

  • Machine learning
  • Proficient with MS Access
  • Proficient with SQL
  • 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 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran.

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Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem. Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem.