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Performance Quality Auditor Lead

Location: Morristown, NJ
JobFamily: Quality
Req #: PS65838
Date Posted: Jan 6, 2022

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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 care companies and a Fortune Top 50 Company.


Job Description

Responsible for evaluating the quality of services and interactions provided by organizations within the enterprise. Included are processes related to enrollment and billing and claims processing, as well as customer service written and verbal inquiries.

Primary duties may include, but are not limited to:

  • Functions as subject matter expert for multiple types of audits, ensuring the implementation and execution of audits, monitoring adherence to the prescribed audit methodologies and documentation, and completing analysis and trending of audit results.
  • Interacts regularly with business and vendor partners, presenting contractual and audit program results, reviewing discrepancies and validating implementation of action plans, managing appeals processes, identifying process improvement opportunities, and performing calibration sessions for various audit scenarios.
  • Acts as a leader for the team, providing training and guidance for audit staff, answering questions from the staff around the audit process or multiple system questions that may arise, and filling in with managerial duties as required.
  • Assists with managing audit workload and ensures operating efficiency for the audit process. 



  • Requires a BA/BS degree and 5 years of experience including 3 years of progressively responsible audit experience, leadership experience or any combination of education and experience which would provide an equivalent background.

Preferred Qualifications

  • Basic understanding of statistics;
  • Thorough understanding of different audit methodologies,
  • In-depth knowledge of multiple systems and proven understanding of processing principles, techniques and guidelines.
  • Excellent organizational, project management, analytical, leadership, verbal and written communication skills required.

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.

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.

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 Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance.

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.