Grievance/Appeals Analyst II – FEP

🔥 48 minutes ago

🦞 Maine, New York, +3 more states – Remote

🦞 Maine – Remote 🗽 New York – Remote 🏈 Ohio – Remote 🏰 Missouri – Remote ⚔️ Virginia – Remote

💵 $21 - $35 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Elevance Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 B2B

Healthcare • Healthcare Insurance • B2B

Elevance Health is transforming from a traditional health benefits organization into a lifetime trusted health partner, driven by a bold purpose to improve the health of humanity. With nearly 100,000 associates, they serve over 118 million people and utilize an integrated whole health approach supported by industry-leading capabilities and a digital health platform. Their mission includes redefining health, reimagining the health system, and strengthening communities.

📋 Description

• Review, analyze, and process non-complex and some complex pre-service and post-service grievances and appeals • Handle grievances and appeals from members, providers, regulators, and third parties • Work across HMO, POS, PPO, EPO, CDHP, and indemnity products • Address clinical and non-clinical services, quality of service, quality of care, executive, and regulatory grievances • Use guidelines and review tools to research grievance and appeal issues, claims, and medical records • Approve cases or summarize and route them to nursing and/or medical staff for review • Follow applicable accreditation, regulatory, department guidelines, and review tools • Complete written communications conveying determinations • Support file-review requirements for URAC and NCQA accreditations • Serve as a liaison with grievance and appeals, medical management, legal, service operations, and other internal departments • Build relationships and promote awareness of customer expectations and responses • Identify opportunities for improvement • Provide support and assistance to Grievance & Appeals Analyst I associates as needed • Exclude utilization or medical management review activities requiring interpretation of clinical information

🎯 Requirements

• HS diploma or equivalent • Minimum of 1 year of Grievance & Appeals analyst experience • Minimum of 3 years of experience working in grievances and appeals, claims, or customer service; or any combination of education and experience providing an equivalent background • Strong oral, written, and interpersonal communication skills • Problem-solving skills • Facilitation skills • Analytical skills • Federal Employees Program experience preferred • Associate degree preferred • Ability to work virtually full-time with required in-person training sessions • Candidates must reside within a reasonable commuting distance from a posting location unless an accommodation is granted as required by law • Certain patient/member-facing roles require COVID-19 and Influenza vaccination unless an acceptable explanation is provided

🏖️ Benefits

• Comprehensive benefits package • Incentive and recognition programs • Equity stock purchase • 401(k) contribution and match • Merit increases • Paid holidays • Paid Time Off • Incentive bonus programs • Medical benefits • Dental benefits • Vision benefits • Short-term disability benefits • Long-term disability benefits • Stock purchase plan • Life insurance • Wellness programs • Financial education resources • COVID-19 and Influenza vaccination coverage/requirement for certain roles, subject to applicable exceptions • Required accommodations for the application process