Grievance/Appeals Analyst I (US)
Company: Elevance Health
Location: Latham
Posted on: January 26, 2023
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Job Description:
Description
Sign-on bonus: $500
This is an entry level position in the Enterprise Grievance &
Appeals Department that reviews, analyzes and processes non-complex
pre service and post service grievances and appeals requests from
customer types (i.e. member, provider, regulatory and third party)
and multiple products (i.e. HMO, POS, PPO, EPO, CDHP, and
indemnity) related to clinical and non clinical services, quality
of service, and quality of care issues to include executive and
regulatory grievances.
Primary duties may include, but are not limited to:
* Reviews, analyzes and processes non-complex grievances and
appeals in accordance with external accreditation and regulatory
requirements, internal policies and claims events requiring
adaptation of written response in clear, understandable
language.
* Utilizes guidelines and review tools to conduct extensive
research and analyze the grievance and appeal issue(s) and
pertinent claims and medical records to either approve or summarize
and route to nursing and/or medical staff for review.
* The grievance and appeal work is subject to applicable
accreditation and regulatory standards and requirements. As such,
the analyst will strictly follow department guidelines and tools to
conduct their reviews.
* The file review components of the URAC and NCQA accreditations
are must pass items to achieve the accreditation.
* Analyzes and renders determinations on assigned non-complex
grievance and appeal issues and completion of the respective
written communication documents to convey the determination.
* Responsibilities exclude conducting any utilization or medical
management review activities which require the interpretation of
clinical information.
* The analyst may serve as a liaison between grievances & appeals
and /or medical management, legal, and/or service operations and
other internal departments.
Requirements:
* HS diploma or GED
* Minimum of 3 years experience working in grievances and appeals,
claims, or customer service; or any combination of education and
experience which would provide an equivalent background.
Preferred Qualifications:
* Demonstrated business writing proficiency, understanding of
provider networks, the medical management process, claims process,
the company's internal business processes, and internal local
technology is strongly preferred.
For URAC accredited areas, the following professional competencies
apply:
Associates in this role are expected to have strong oral, written
and interpersonal communication skills, problem-solving skills,
facilitation skills, and analytical skills.
Please be advised that Elevance Health only accepts resumes from
agencies that have a signed agreement with Elevance Health.
Accordingly, Elevance Health is not obligated to pay referral fees
to any agency that is not a party to an agreement with Elevance
Health. Thus, any unsolicited resumes, including those submitted to
hiring managers, are deemed to be the property of Elevance
Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives
and communities and making healthcare simpler. Previously known as
Anthem, Inc., we have evolved into a company focused on whole
health and updated our name to better reflect the direction the
company is heading.
We are looking for leaders at all levels of the organization who
are passionate about making an impact on our members and the
communities we serve. You will thrive in a complex and
collaborative environment where you take action and ownership to
solve problems and lead change. Do you want to be part of a larger
purpose and an evolving, high-performance culture that empowers you
to make an impact?
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.
The health of our associates and communities is a top priority for
Elevance Health. We require all new candidates to become vaccinated
against COVID-19. If you are not vaccinated, your offer will be
rescinded unless you provide and Elevance Health approves a valid
religious or medical explanation as to why you are not able to get
vaccinated that Elevance Health is able to reasonably accommodate.
Elevance Health will also follow all relevant federal, state and
local laws.
Elevance Health has been named as a Fortune Great Place To Work in
2021, is ranked as one of the 2021 World's Most Admired Companies
among health insurers by Fortune magazine, and a Top 20 Fortune 500
Companies on Diversity and Inclusion. To learn more about our
company and apply, please visit us at careers.ElevanceHealth.com.
Elevance Health is 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. Applicants who require accommodation to
participate in the job application process may contact
ability@icareerhelp.com for assistance.
Keywords: Elevance Health, Albany , Grievance/Appeals Analyst I (US), Professions , Latham, New York
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