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Grievance/Appeals Representative I

Anthem, Inc

This is a Full-time position in Anaheim, CA posted February 23, 2021.

nnDescription nn nnSHIFT: Day Jobnn nnSCHEDULE: Full-timenn nnYour Talent.

Our Vision.

At Anthem, Inc., its a powerful combination, and the foundation upon which were 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.

nn nnThis 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.nn nnLocation: Remote opportunity, you must reside within an hour’s commute of an Anthem location.nn nnIn this role as Grievance/Appeals Representative I, you are responsible for reviewing, analyzing and processing claims in accordance with policies and claims events to determine the extent of the company’s liability and entitlement.

nn nnPrimary duties may include, but are not limited to:nn nnConducts investigation and review of customer grievances and appeals involving provision of service and benefit coverage issues.

nn nnContacts customers to gather information and communicate disposition of case; documents interactions.

nn nnGenerates written correspondence to customers such as members, providers and regulatory agencies.

nn nnPerforms research to respond to inquiries and interprets policy provisions to determine the extent of company’s liability and/or provider’s/beneficiaries entitlement.

nn nnResponds to appeals from CS Units, Provider Inquiry Units, members, providers and/or others for resolution or affirmation of previously processed claims.

nn nnEnsures appropriate resolution to inquiries, grievances and appeals within specified timeframes established by either regulatory/accreditation agencies or customer needs.

nn nnIdentifies barriers to customer satisfaction and recommends actions to address operational challenges.

nn nnQualifications nn nnRequires a HS Diploma or equivalent; 1-3 years experience in health insurance business including customer service experience; or any combination of education and experience, which would provide an equivalent background.

nn nnGood verbal and written communication, organizational and interpersonal skills.

nn nnComputer proficiency and MS Office skills required.nn nnAnthem, Inc.

is ranked as one of Americas 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 careers.antheminc.com.

An Equal Opportunity Employer/Disability/Veteran.

Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.nn nnREQNUMBER: PS43753-Californiann

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