Grievance Analyst

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.

• 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 to either approve or summarize and route to nursing and/or medical staff for review.
• Ensure strict adherence to department guidelines and tools to conduct reviews, meeting applicable accreditation and regulatory standards and requirements.
• Analyze and render determinations on assigned non-complex grievance and appeal issues and completion of written communication documents to convey the determination.
• Collaborate with grievances & appeals, medical management, legal, and/or service operations, and other internal departments as needed.

• High School diploma or equivalent required.
• Minimum of 3 years of experience working in grievances and appeals, claims, or customer service; or any combination of education and experience providing an equivalent background.

• Demonstrated business writing proficiency, understanding of provider networks, medical management process, claims process, company's internal business processes, and internal local technology.

Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution. The salary range for this position is $21.42/hr. to $32.12/hr., depending on location and experience.

We are an Equal Employment Opportunity employer and welcome applications from diverse candidates. If you are passionate about making a difference in the lives of our members and communities, we encourage you to apply.