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Anthem, Inc. Benefits Analyst III in Apple Valley, California


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.

This position will allow remote work within the US

does require some occasional weekend work

Responsible for identifying complex business needs and translates the needs into application software requirements in support of operations, productions and projects.

Primary duties may include, but are not limited to:

Designs and builds new complex non-standard benefit plans, reviews and analyze benefit summaries; and identifies best approach to code/develop benefits to achieve optimum adjudication levels.

Maintains avoidance to negative financial, regulatory, and operational impact. Performs testing and quality assurance of new product developed.

Research and analysis of RFP proposals, and product projects.

Create and maintain issue log on appropriate tool, resolve defects based on knowledge and analysis of system functionality.

Researches and responds to complex inquiries from various departments.

May consult with and mentoring of less experienced team members.

Serves as trainer for standard and highly customized benefit configuration. Represents department in production related meetings including product development, design and implementation.

Must be able to perform all duties of lower level positions as directed by management.

Additional duties as follows:

  • Translate and configure product data into a Anthems standardized product model structure

  • Review and analyze product data from client sources and product development (such as databases and/or spreadsheet)s and determine how to model in Anthem’s product configuration software

  • Communicate data model and product changes to modelers, developers, claims, QA, business partners and others as needed in a clear and consistent manner.

  • Create and execute test cases, reports, and scripts to ensure validity and accuracy of work.

  • Manage lifecycle of product data using standard software development methodologies.

  • Develop a thorough understanding of the product model structure.

  • Understand the insurance products supported by Anthem

  • Write requirement documentation, product definitions, and maintain existing documentation. Understand how product data is utilized by claims, customer facing applications, and other integrated systems


Requires a BA/BS degree in a related field

3-5 years experience in claims processing, previous medical health care, analytical experience, or project management experience

5 + years of benefit coding experience preferred

Or any combination of education and experience that would provide an equivalent background

Additional preferred skills:

  • Experience with medical insurance and claims details (Place of Service, procedure codes, diagnosis codes, etc)

  • 3+ years experience with Anthem WGS ecosystem a plus

  • 3+ years experience with Anthem SPIDER system a plus

  • Experience with agile methodologies a plus

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.