Grievances & Appeals Risk Analyst II

3 weeks ago

Norfolk, United States Elevance Health Full time
Description

Title: Grievances & Appeals Risk Analyst II

Location: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.

The Grievances & Appeals Risk Analyst II will be responsible for providing support services for multiple states, enterprise-wide functions and/or complex issues through complex assignments and projects, which utilize recognized areas of specialization and knowledge specific to the company.

How you will make an impact:
  • Prepares, analyzes and evaluates written correspondence such as complaints, grievances, document demands, alleged ERISA violations and researches to resolve problems and close outstanding issues at the state or enterprise level.
  • Conducts research and analysis, recommends appropriate course of action and next steps.
  • Performs fact checking, gathers documents, researches and responds to records requests, and various inquiries from internal and external sources, coordinates investigative and discovery activities specific to Grievance and Appeal functions.
  • Assists with compliance issues as needed.
  • Attends and represents Grievances & Appeals at appropriate legal proceedings and arbitration hearings under supervision of counsel.
  • Participates on projects and may participate in negotiations and strategizing with business and staff.
  • Enters information as required into appropriate databases or other document management systems.
  • May serve as a resource to other support staff.
Minimum Requirements
  • H.S. diploma
  • Minimum of 5 years of related experience; or any combination of education and experience which would provide an equivalent background.
Preferred Qualifications
  • BA/BS in a related field is preferred.
  • Paralegal certification and experience preferred.
For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $29.24/hr. to $43.86/hr.

Locations: California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJ

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. 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.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

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.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.comfor assistance.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

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.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.comfor assistance.

  • Grievances & Appeals Risk Analyst I

    1 week ago

    Norfolk, United States Elevance Health Full time

    Job Family: CLM > Claims Support Type: Full time Date Posted: May 20, 2024 Anticipated End Date: Jun 10, 2024 Reference: JR116616 Description **Title: Grievances & Appeals Risk Analyst I** The **Grievances & Appeals Risk Analyst I **will be responsible for responding to inquiries received from regulatory agencies for one or more states or functions...

  • Risk Analyst

    4 weeks ago

    Norfolk, United States Risk Mitigation Consulting Full time

    **RMC is seeking a Risk Analyst with DoD Secret Clearance for a remote position in the Norfolk, VA area.** Are you ready to embark on a fulfilling and impactful career journey with Risk Mitigation Consulting (RMC)? We're in search of exceptional Risk Analysts to become part of our mission-driven team, dedicated to making a difference in the federal and...

  • Legal Analyst

    1 month ago

    Norfolk, United States A. Reddix & Associates Full time

    Job DescriptionJob DescriptionDescription:The primary duty of the Legal Analyst is to assist in the Appeals outreach/communications and reconsideration review process with CMS and conduct reviews of appeals requests. The Legal Analyst will also conduct legal coding and privilege reviews of sensitive data. The Legal Analyst will serve as a consultant and SME...

  • Legal Analyst

    3 weeks ago

    Norfolk, United States A. Reddix & Associates Full time

    Job DescriptionJob DescriptionDescription:The primary duty of the Legal Analyst is to assist in the Appeals outreach/communications and reconsideration review process with CMS and conduct reviews of appeals requests. The Legal Analyst will also conduct legal coding and privilege reviews of sensitive data. The Legal Analyst will serve as a consultant and SME...

  • Ar Specialist Ii- Clinical Appeals

    4 weeks ago

    Norfolk, United States Sentara Healthcare Full time

    **Sentara Health** is seeking to hire a qualified individual to join our team as a **AR Specialist II Clinical Appeals** **Position Status**: Full-time, Day Shift **Position Location**:Norfolk, VA **Standard Working Hours**: 8:00AM to 5:00PM (ET). **Position Summary**: Responsible for the billing of insurance claims and/or the resolution of issues...

  • C5isr Modernization Analyst

    6 days ago

    Norfolk, United States CACI Full time

    C5ISR Modernization Analyst Job Category: Service Contract Act Time Type: Full time Minimum Clearance Required to Start: Secret Employee Type: Regular Percentage of Travel Required: Up to 10% Type of Travel: Continental US - * CACI is actively seeking to hire an Analyst for the C5ISR Modernization Process to help support the Naval Surface Warfare...

  • Business Process Analyst Ii

    5 days ago

    Norfolk, United States Cybrex LLC Full time

    **Business Process Analyst II** At least 5 years of experience in the field or in a related area. Familiar with a variety of the field’s concepts, practices, and procedures. Relies on extensive experience and judgment to plan and accomplish goals. May lead and direct the work of others. Develops, analyses, evaluates, advises on, and/or improves the...

  • Computer Systems Analyst II

    1 week ago

    Norfolk, United States Amentum Full time

    Amentum is seeking a Computer Systems Analyst II to assist our Navy customer with systems and technical engineering services. We will implement your expertise through a disciplined and rigorous Systems Engineering (SE) process across all mission areas of the system under development and sustainment. Using your prowess and experience, help our customer...

  • C5ISR Modernization Analyst

    4 weeks ago

    Norfolk, Virginia, United States CACI International Full time

    C5ISR Modernization AnalystJob Category: Service Contract ActTime Type: Full timeMinimum Clearance Required to Start: SecretEmployee Type: RegularPercentage of Travel Required: Up to 10%Type of Travel: Continental USCACI is actively seeking to hire an Analyst for the C5ISR Modernization Process to help support the Naval Surface Warfare Center, Corona...

  • C5ISR Modernization Analyst

    3 weeks ago

    Norfolk, Virginia, United States CACI International Full time

    C5ISR Modernization AnalystJob Category: Service Contract ActTime Type: Full timeMinimum Clearance Required to Start: SecretEmployee Type: RegularPercentage of Travel Required: Up to 10%Type of Travel: Continental USCACI is actively seeking to hire an Analyst for the C5ISR Modernization Process to help support the Naval Surface Warfare Center, Corona...

  • Risk & Performance Analyst

    4 weeks ago

    Norfolk, United States PRA Group Full time

    We invite you to explore a future with us at PRA Group, a diverse and growing company that has a tangible impact on the global economy. Position Summary: Responsible for providing analytical, performance reporting, and project management support for PRA Group Inc.'s Enterprise Risk Management ("ERM") Division. Primary focus includes supporting activities...

  • Risk & Performance Analyst

    1 month ago

    Norfolk, United States PRA Group Full time

    We invite you to explore a future with us at PRA Group, a diverse and growing company that has a tangible impact on the global economy. Position Summary:  Responsible for providing analytical, performance reporting, and project management support for PRA Group Inc.’s Enterprise Risk Management (“ERM”) Division. Primary focus includes supporting...

  • Business Process Analyst II

    2 months ago

    Norfolk, United States Cybrex LLC Full time

    Cybrex is in the process of bidding a new Cyber/IT Services Proposal and is sourcing for potential staff. This position is one of many where we are accepting applications, doing interviews and making contingent employment offers with negotiated salary amounts. Upon a win the Contingent offer would become a permanent offer at the previously agreed upon...

  • Business Process Analyst II

    2 months ago

    Norfolk, United States Cybrex LLC Full time

    Job DescriptionJob DescriptionCybrex is in the process of bidding a new Cyber/IT Services Proposal and is sourcing for potential staff. This position is one of many where we are accepting applications, doing interviews and making contingent employment offers with negotiated salary amounts. Upon a win the Contingent offer would become a permanent offer at the...

  • Business Process Analyst II

    3 weeks ago

    Norfolk, United States Cybrex LLC Full time

    Job DescriptionJob DescriptionCybrex is in the process of bidding a new Cyber/IT Services Proposal and is sourcing for potential staff. This position is one of many where we are accepting applications, doing interviews and making contingent employment offers with negotiated salary amounts. Upon a win the Contingent offer would become a permanent offer at the...

  • Budget Process Analyst Ii

    2 weeks ago

    Norfolk, United States ManTech Full time

    **Secure our Nation, Ignite your Future** Become an integral part of a diverse team while working at an Industry Leading Organization, where our employees come first. At **ManTech International**, you’ll help protect our national security while working on innovative projects that offer opportunities for advancement. Currently, **ManTech **is seeking a...

  • Business Consultant Sr

    2 months ago

    Norfolk, United States Elevance Health Full time

    Location: Indianapolis IN, Norfolk VA, Tampa FL, Atlanta GA Hours: Standard M – F Travel: Hybrid (1-2 days onsite per week) Position Overview: Responsible for translating most highly complex and varied business needs into application software requirements. These needs typically involve a significant expenditure or cost savings and impact a wide range of...

  • Business Consultant Sr

    3 weeks ago

    Norfolk, United States Elevance Health Full time

    Location: Indianapolis IN, Norfolk VA, Tampa FL, Atlanta GA Hours: Standard M – F Travel: Hybrid (1-2 days onsite per week) Position Overview: Responsible for translating most highly complex and varied business needs into application software requirements. These needs typically involve a significant expenditure or cost savings and impact a wide range of...

  • TSRA Metrics Support Systems Analyst II

    2 weeks ago

    Norfolk, United States Epsilon Systems Full time

    Epsilon Systems Solutions, Inc. has a contingent job opportunity for a full-time TSRA Metrics Support Systems Analyst II in Norfolk, VA. Summary: The TSRA Metrics Support System Analyst II will support Mid Atlantic Regional Maintenance Center (MARMC) Code 211. Roles and Responsibilities: •Maintain MARMC surface TSRA metrics and support mandatory...

  • Cyber Support Analyst

    4 weeks ago

    Norfolk, United States Watershed Security Full time

    Job DescriptionJob DescriptionCOMPANY OVERVIEWWatershed Security is a Veteran Owned Small Business and a leader in providing quality Cyber Security Services to the Federal Government. Watershed is a great place to work, offering a challenging and respectful work environment. We are growing fast and strive to deliver our vision every day: “To inspire trust...