Grievance Analyst

1 week ago

Richmond, Virginia, United States Elevance Health Full time
About the Role

We are seeking a highly skilled Grievance/Appeals Analyst I to join our team at Elevance Health. As a key member of our Enterprise Grievance & Appeals Department, you will play a critical role in reviewing, analyzing, and processing non-complex grievances and appeals requests from various customer types and products.

Key Responsibilities
  • Review and analyze non-complex grievances and appeals in accordance with external accreditation and regulatory requirements, internal policies, and claims events.
  • Utilize guidelines and review tools to conduct extensive research and analyze grievance and appeal issues, pertinent claims, and medical records.
  • Analyze and render determinations on assigned non-complex grievance and appeal issues and complete written communication documents to convey the determination.
  • Collaborate with internal departments, including grievances & appeals, medical management, legal, and service operations.
Requirements
  • High School diploma or GED
  • Minimum of 3 years of experience working in grievances and appeals, claims, or customer service
Preferred Skills
  • Demonstrated business writing proficiency and understanding of provider networks, medical management processes, claims processes, and internal business processes
About Elevance Health

Elevance Health is a health company dedicated to improving lives and communities. 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.

We offer a range of market-competitive total rewards, including merit increases, paid holidays, Paid Time Off, and incentive bonus programs. Elevance Health operates in a Hybrid Workforce Strategy, requiring associates to work at an Elevance Health location at least once per week. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

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