Overview
Grievance/Appeals Rep II Jobs in Woburn, MA at Elevance Health
Anticipated End Date:
2024-06-24
Position Title:
Grievance/Appeals Rep II
Job Description:
Location: Hybrid in Woburn, MA
Hours: Monday-Friday 8-5pm 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 2 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.
Job Level:
Non-Management Non-Exempt
Workshift:
1st Shift (United States of America)
Job Family:
CLM > Claims Support
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…
Title: Grievance/Appeals Rep II
Company: Elevance Health
Location: Woburn, MA
Category:
