Senior Appeals Representative

🔥 7 minutes ago

🐊 Florida, Ohio, +2 more states – Remote

🐊 Florida – Remote 🏈 Ohio – Remote 🤠 Texas – Remote 🍑 Georgia – Remote

⏰ Full Time

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

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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

• Investigate and review customer appeals regarding provision of service and benefit coverage issues • Triage clinical and non-clinical inquiries, grievances and appeals • Prepare case files for member grievance committees and hearings • Summarize and present essential information to clinical specialists, medical directors and legal counsel • Respond to oral and written complaints • Resolve inquiries, grievances and appeals within regulatory, accreditation or customer-specified timeframes • Contact customers to gather information and communicate case dispositions; document interactions • Generate written correspondence to members, providers and regulatory agencies • Identify barriers to customer satisfaction and recommend actions to address operational challenges • Pursue ongoing education and training on benefits and services • Document and log inquiry, appeal and grievance information in tracking systems • Resolve complex customer issues requiring adapted responses or extensive research • Make administrative exceptions within prescribed guidelines • Investigate, summarize and recommend resolutions for non-clinical cases • Assist grievance and appeals staff with file decisions • Provide direction and guidance to team members • Provide leadership and foster a supportive environment • Perform other related duties as required

🎯 Requirements

• High school diploma or equivalent • Minimum 4 years related experience working in grievances and appeals • Or any combination of education and/or experience which would provide an equivalent background • Foreign national applicants must have lived in the United States for at least three of the past five years • Understanding of the application of benefits contracts, pricing, policies and legislative regulations • Verbal and written communication skills • Organizational skills • Interpersonal skills • PC proficiency strongly preferred • Appeals knowledge preferred • Knowledge of Part A and B Medicare preferred • Candidates must reside within a reasonable commuting distance from the posting location(s), unless accommodation is granted as required by law • Certain patient/member-facing roles require vaccination against COVID-19 and Influenza

🏖️ Benefits

• Merit increases • Paid holidays • Paid Time Off • Incentive bonus programs • Medical benefits • Dental benefits • Vision benefits • Short-term disability benefits • Long-term disability benefits • 401(k) + match • Stock purchase plan • Life insurance • Wellness programs • Financial education resources • Virtual full-time work, except for required in-person training sessions • Ongoing education/training

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