Anthem Inc. Medical Jobs

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Anthem, Inc. Manager I or II - Grievance/Appeals in Richmond, Virginia

Description

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 benefits companies and a Fortune Top 50 Company.

Manager I or II - Grievance/Appeals – PS45077

*The manager will determine level at time of hire based upon experience level.

Location: Virginia, New York, Indiana, Las Vegas, Colorado

Manager I Grievance/Appeals

Responsible for management oversight of receipt, investigation and processing associated with member/provider grievance and appeals.

Primary duties may include, but are not limited to:

  • Monitors, trends and analyzes grievance and appeals data for submission to appropriate parties.

  • Serves as clinical resource expert and mentor to unit and other departments for complex issues and interpretation of regulatory standards.

  • May perform internal audits of grievance and appeals process.

  • Ensures appeals and grievances are resolved within regulatory timeframes.

  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Manager II Grievance/Appeals

Responsible for management oversight of grievances and appeals departmental units to investigate, resolve, and respond to client/provider grievances/appeals and ensure compliance with regulatory requirements.

Primary duties may include, but are not limited to:

  • Maintains and coordinates staff activities to achieve departmental and corporate goals to improve service to customers/providers and assures regulatory compliance.

  • Analyzes and develops strategies by achieving performance thresholds within budgetary guidelines.

  • Addresses both internal/external customer/provider needs and concerns related to team activities.

  • Ensures programs support overall QI program and meet regulatory compliance/accreditation and the company standards.

  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Qualifications

Manager I Grievance/Appeals

Requires 3-5 years leadership experience in grievance & appeals, claims or customer services in the healthcare industry; or any combination of education and experience, which would provide an equivalent background. BA/BS preferred. For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Manager II Grievance/Appeals

Requires 5 + years grievance & appeals experience and 3-5 years of management experience in the healthcare industry; or any combination of education and experience, which would provide an equivalent background. BA/BS preferred.For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Applicable to Colorado Applicants Only

Annual Salary Range*: $79,044.08- $98,805.04

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

  • The salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

    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. An Equal Opportunity Employer/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 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.

REQNUMBER: PS45077

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