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Anthem, Inc. Clinical Compliance Consultant Sr in Watertown, Massachusetts


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

Please note: this position is currently remote due to COVID. Once we go back to standard operations, this position will be office-based and located in one of the Anthem offices.

Responsible for supporting regulatory compliance for a state, delegated entities, or enterprise wide for designated lines of business through project leadership, technical oversight and risk identification and mitigation.

Primary duties may include, but are not limited to:

  • Serves as point of contact, coordinating and collaborating with regulatory bodies and business partners to ensure compliance with regulatory, accrediting and Health Plan quality of care and service requirements.

  • Assists with the interpretation of applicable laws and regulations.

  • Develops tools that assist in determining exposure to regulatory and/or accreditation risks.

  • Identifies opportunities to manage and mitigate those risks.

  • Works with business management areas to develop metrics for monitoring program objectives and policies and procedures that support compliance with regulatory and accreditation standards.

  • Compiles information related to quality improvement and compliance monitoring activities for internal use and external audits and maintains relevant records.

  • Provides guidance and oversight to business units to ensure ongoing regulatory or accreditation compliance and monitors corrective action plans relating to regulatory or accreditation compliance.

  • Makes recommendations to business unit partners for improvements or remediation to risk management, regulatory, and accreditation compliance programs.

  • Monitors development and use of metrics for regulatory compliance.

  • Monitors business unit initiatives relating to the development and implementation of a risk management program for utilization management activities.

  • Collaborates with enterprise quality team, enterprise care management, and other teams on regulatory initiatives.

  • Creates audit tools, reports, standardized policies and procedures, and manuals.

  • Facilitates implementation of survey or regulatory recommendations.

  • Recommends new processes.

  • Trains associates on new and revised standards.


  • Requires a BS/BA; 5 years of professional experience including 3 years of regulatory, compliance, accreditation, and/or auditing experience or any combination of education and experience, which would provide an equivalent background.

  • Ability to travel may be required.

  • Knowledge of regulatory requirements such as experience with CMS and state regulatory and accreditation requirements preferred.

  • AnEqualOpportunityEmployer/Disability/Veteran

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran.