Overview
Appeals Coordinator Jobs in Wixom, MI at Elevance Health
Anticipated End Date:
2024-06-24
Position Title:
Appeals Coordinator
Job Description:
Location: 100% Remote
Hours: Monday-Friday 11-7:30pm EST
TheGrievance/Appeals Rep IIis responsible for reviewing, analyzing and processing policies related to claims events to determine the extent of the company’s liability and entitlement.
How you will make an impact:
Conducts investigation and review of customer grievances and appeals involving provision of service and benefit coverage issues.
Contacts customers to gather information and communicate disposition of case; documents interactions.
Generates written correspondence to customers such as members, providers and regulatory agencies.
Researches administrative or non-clinical aspects of the appeal, e.g. eligibility, benefit levels, overall adherence to policies and practices.
May make decision on administrative appeals where guidelines are well documented and involve limited discretion.
Prepares files for internal or external review by analysts, medical staff or outside consultant.
Triages clinical and non-clinical inquiries, grievances and appeals, prepares case files for member grievance committees/hearings.
Summarizes and presents essential information for the clinical specialist or medical director and legal counsel.
Requirements:
HS diploma or equivalent and a minimum of 1 years experience in customer service, preferably in a managed care environment, medical office, or health insurance; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities and Experience:
Ability to organize work, set and manage multiple priorities in a time sensitive manner is strongly preferred.
Good oral and written communication skills, basic word processing, data base management, spreadsheet skills, PC proficiency and claims knowledge strongly preferred.
For candidates working in person or remotely in the locations below, the hourly* range for this specific position is $14.45 to $28.69.
Locations: California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJ
I 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 …
Title: Appeals Coordinator
Company: Elevance Health
Location: Wixom, MI
Category:
