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Anthem Process Expert Jobs (NOW HIRING)

True Team Medical

Supervisor

Myrtle Beach, SC

$64K - $83K/yr

... Process * Facilitate weekly group supervision and individual supervision of MST Therapists ... Actively collaborate with the MST Expert around implementation of MST and ensure continued ...

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Anthem Process Expert information

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$37

$55

$66

How much do anthem process expert jobs pay per hour?

As of Jun 16, 2026, the average hourly pay for anthem process expert in the United States is $55.83, according to ZipRecruiter salary data. Most workers in this role earn between $53.61 and $57.69 per hour, depending on experience, location, and employer.

What is the difference between Anthem Process Expert vs Anthem Claims Specialist?

AspectAnthem Process ExpertAnthem Claims Specialist
Required CredentialsHigh school diploma or equivalent; certifications in healthcare or insurance preferredHigh school diploma or equivalent; insurance or healthcare certifications advantageous
Work EnvironmentOffice setting, collaborative teams, process improvement focusOffice or call center, customer service oriented, claims processing
Employer & Industry UsageInsurance companies, healthcare providers, managed care organizationsHealth insurance companies, claims processing centers
Common Search & Comparison IntentUnderstanding roles in healthcare insurance processesComparing claims processing roles within insurance companies

The Anthem Process Expert focuses on optimizing and improving insurance processes within healthcare organizations, often involving workflow analysis and process enhancements. In contrast, the Anthem Claims Specialist primarily handles the review and processing of insurance claims, ensuring accurate and timely payments. Both roles require knowledge of insurance procedures and may share similar certifications, but their core responsibilities differ in scope and focus.

What are some of the main challenges Anthem Process Experts face when optimizing workflow processes, and how can these be addressed?

Anthem Process Experts often encounter challenges such as resistance to change from team members, coordinating across multiple departments with varying priorities, and ensuring process improvements align with compliance standards. Addressing these challenges requires strong communication and facilitation skills, as well as a collaborative approach to gain stakeholder buy-in. Leveraging data-driven analysis and maintaining flexibility in solution design can also help overcome obstacles and drive successful process optimization.

What are the key skills and qualifications needed to thrive as an Anthem Process Expert, and why are they important?

To thrive as an Anthem Process Expert, you need a thorough understanding of business process management, data analysis, and healthcare operations, typically supported by experience in process improvement methodologies like Lean or Six Sigma. Familiarity with workflow management systems, data analytics tools, and healthcare regulations such as HIPAA is essential. Strong problem-solving abilities, attention to detail, and effective communication skills distinguish top performers in this role. These skills are crucial for streamlining processes, ensuring compliance, and driving efficiency within healthcare organizations.

What is an Anthem Process Expert?

An Anthem Process Expert is a professional who specializes in analyzing, improving, and overseeing business processes within Anthem, Inc., a leading health insurance provider. They work to streamline workflows, enhance operational efficiency, and ensure compliance with industry standards. Their responsibilities often include mapping out current processes, identifying areas for improvement, and collaborating with various teams to implement best practices. This role is crucial in helping Anthem deliver high-quality services to members and providers while optimizing internal operations.
Infographic showing various Anthem Process Expert job openings in the United States as of June 2026, with employment types broken down into 94% Full Time, 2% Part Time, and 4% Contract. Highlights an 94% Physical, 2% Hybrid, and 4% Remote job distribution, with an average salary of $116,128 per year, or $55.8 per hour.

Subject Matter Expert - Credentialing (State of Indiana)

Calpion/Plutus Health

Addison, TX • On-site

Full-time

Posted 17 days ago

Job description

Role Summary
The Subject Matter Expert (SME) - Provider Credentialing (Indiana) serves as the authoritative resource for all credentialing, re-credentialing, and enrollment activities within the state of Indiana. This role provides strategic guidance, issue resolution, and subject expertise across Medicare, Indiana Medicaid, and commercial payers, ensuring regulatory compliance, payer alignment, and timely provider onboarding. The SME works closely with clients, internal teams, and offshore credentialing partners to address complex credentialing scenarios and optimize operational outcomes specific to Indiana.
Core Responsibilities
  • Act as the primary Subject Matter Expert for Indiana provider credentialing, including state-specific rules, timelines, and payer nuances
  • Provide expert guidance on initial credentialing, re-credentialing, and enrollment for Medicare, Indiana Medicaid (IHCP / Hoosier Healthwise, HIP, MCOs), and commercial payers
  • Serve as the escalation point for complex Indiana credentialing cases, denials, and payer delays
  • Interpret and apply Indiana-specific regulatory and payer requirements to ensure compliance and accuracy
  • Guide offshore and internal teams on Indiana Medicaid enrollment processes, including MCO credentialing workflows
  • Review provider applications and documentation for state-specific completeness and accuracy
  • Engage directly with Indiana payer enrollment departments to resolve issues and accelerate approvals
  • Ensure provider data accuracy across CAQH, PECOS, NPPES, and payer portals relevant to Indiana
  • Maintain oversight of credentialing trackers and dashboards with a focus on Indiana-based providers
  • Support internal and external audits, ensuring adherence to HIPAA and Indiana payer guidelines
  • Collaborate with sales and client success teams to provide Indiana credentialing expertise during onboarding and expansion
  • Contribute to process improvements, SOP development, and training materials related to Indiana credentialing

Indiana-Specific Expertise
  • In-depth knowledge of Indiana Health Coverage Programs (IHCP)
  • Experience with Hoosier Healthwise, Healthy Indiana Plan (HIP), CareSource, Anthem Indiana, Managed Health Services (MHS), UnitedHealthcare Community Plan Indiana
  • Familiarity with Indiana Family and Social Services Administration (FSSA) credentialing requirements
  • Understanding of Indiana Medicaid revalidation and enrollment timelines
  • Expertise in Indiana-specific payer escalation paths and common enrollment bottlenecks

Required Qualifications
  • 10+ years of U.S. provider credentialing experience, with deep hands-on expertise in Indiana credentialing
  • Strong working knowledge of Indiana Medicaid, Medicare, and commercial payer enrollment
  • Extensive experience using CAQH, PECOS, NPPES, and Indiana-relevant payer portals
  • Proven ability to resolve complex credentialing issues and guide teams through escalations
  • Excellent communication, documentation, and stakeholder management skills

Tools & Systems
  • CAQH, PECOS, NPPES
  • OIG, SAM, Indiana Medicaid Exclusion Lists
  • Medicare Opt-Out List
  • Social Security Death Master File (SSDMF)
  • Payer portals: Anthem Indiana, UHC Indiana, Cigna, Humana, Indiana Medicaid MCO portals
  • Credentialing dashboards and Excel-based trackers

Apply