Anthem, Inc. Grievance/Appeals Rep Ld in Mason, Ohio
SHIFT: Day Job
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.
Responsible for conducting compliance audits on senior Grievance/Appeals Reps and below.
Primary duties may include, but are not limited to:
Coaches Grievance/Appeals Reps to achieve quality and timeliness standards and monitors all case handling to ensure consistency and accuracy.
Facilitates second level panel meetings.
Acts as the liaison with the Legal Department.
Performs appeals analysis/trending and pursues recommendations for corrective actions to reduce the number of appeals and/or improve the timeliness of appeal resolution.
Develops training materials and conducts one on one as well as group training.
Oversees Grievance/Appeals accreditation compliance and compliance with regulations in 51 jurisdictions.
Requires a HS Diploma or equivalent and 5 years progressively complex experience working in grievances and appeals, understanding of the application of benefits contracts, pricing, policies and legislative regulations, verbal and written communication skills, organizational skills, interpersonal skills, PC proficiency, or any combination of education and experience which would provide an equivalent background.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
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 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.