Remote Anthem Jobs in Riverside, CA (NOW HIRING)

Location: 100% fully remote. (Travel is 5% if in southern California).

Overview :

• A multi-payor healthcare organization contracting with 15 health plans across the Southern California market. The organization generates over $2.5 billion in annual revenue and manages a monthly membership of more than 500,000 lives. Primary market focus includes the Inland Empire and San Diego regions, with close collaboration wand engagement across Los Angeles and Orange County markets.

• HMO business consists of commercial, point of service, Covered California (ACA) and is analyzed at the plan level.

• Medi-Cal is broken into categories such as TANF, SPD, Dual, LIC, LTC and separated by Los Angeles, San Bernardino/Riverside, and Orange counties.

• Medicare business consists of understanding CMS bids, rebates, HCC, RAF scores, risk types, revenue definitions (Parts A & B), and payment integrity.

• Contracts with health plans such as Aetna, Anthem Blue Cross, Alignment, Blue Shield, IEHP, HealthNet, Humana, SCAN, UHC, Molina, Alignment, Central, Sharp, Scripps, and AHMC.

• The Inland Empire and San Diego market is broken up into three LCDOs, EPIC, NAMM, and San Diego.

• Team goals include developing and strengthening existing talent, driving system integration, and leading migration to CapRev to enable real-time data visibility across key partner teams such as Accounting, Payor Contracting, and FP&A. The team is focused on delivering accurate, comprehensive reporting while leveraging large, complex datasets and maintaining a strong understanding of granular data details.

Position Details:

• Must be team oriented and able to manage time effectively. Should be an expert with Excel and must know SQL.

• Ability to analyze complex data from multiple health plans in a timely manner relating to capitation revenue, CMS ARC codes, payment methodologies, and various plan codes.

• Submit month end data loads to Accounting by WD -6. This includes data analysis by health plan and products assigned, reconciliation of data relating to membership, revenue, and PMPM, remittances, cash, SOX documentation regarding highlights for MoM analysis.

• Work through ad hoc requests and submit reports accurately and on time.

• Communicate effectively both verbally and written, present in meetings while working remotely from home.

• Potential challenges include migration to CapRev and working with multiple different teams.

Candidate Profile:

• Looking for a self-motivated individual with a curious mindset - someone who is eager to learn, ask questions, and continuously grow. The ideal candidate is driven to make meaningful impact, takes initiative, and thrives in an environment where innovation and improvement are encouraged.

• Has experience in healthcare administration, including managing and analyzing capitation revenue, with a strong understanding of value-based care models and financial performance.

• Must maintain a positive attitude and demonstrate flexibility to adapt as business needs evolve.

• Ability to show expert excel skills and able to write basic queries in SQL.

• Must be able to meet month end Accounting deadlines and can effectively communicate highlights clearly and concisely in an open forum.

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Bachelor's degree OR certification in Accounting, Finance or IT related field

• 5 years of healthcare experience

• Advanced level of proficiency in Microsoft (Outlook, Word, Excel, PowerPoint)

Preferred Qualifications:

• Strong analytical skills

• Master's degree or certification in Accounting, Finance or IT related field

• Master of Business Administration (MBA)

• SQL 

• Experience with large data sets

Soft Skills:

• Self-motivated, organized, and possesses a high degree of autonomy and maturity

• Communicate verbally and written exceptionally well. Speak and present in meetings

• Fast learner with ability to adapt

• Ability to multi-task and operate at a high-level under pressure

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. 

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action 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.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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