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Grievance/Appeals Representative I
2 months ago
We are seeking a highly skilled Grievance/Appeals Representative I to join our team at Elevance Health. As a key member of our organization, you will play a critical role in reviewing, analyzing, and processing claims to determine the extent of our liability and entitlement.
Key Responsibilities- Conduct thorough investigations and reviews of customer grievances and appeals, ensuring accurate and timely resolutions.
- Communicate effectively with customers, gathering information and providing clear disposition of cases.
- Generate written correspondence to customers, including members, providers, and regulatory agencies.
- Perform research to respond to inquiries and interpret policy provisions to determine our liability and/or provider's/beneficiary's entitlement.
- Respond to appeals from various sources, ensuring appropriate resolution within specified timeframes.
To be successful in this role, you will need:
- A high school diploma or equivalent and a minimum of 1 year of experience in health insurance business, including customer service experience.
- Excellent verbal and written communication, organizational, and interpersonal skills.
- Proficiency in PC applications and software.
At Elevance Health, we offer a range of market-competitive total rewards, including merit increases, paid holidays, and incentive bonus programs. We also provide medical, dental, vision, short and long-term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs, and financial education resources.
We operate in a Hybrid Workforce Strategy, requiring associates to work at an Elevance Health location at least once per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
We are 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.
