Grievances & Appeals Representative
HumanaSalary not specified
Full Time
Junior (1 to 2 years)
Not SpecifiedCompensation
Entry Level & New GradExperience Level
Full TimeJob Type
UnknownVisa
Healthcare, InsuranceIndustries
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
Responsibilities
- 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
- Analyzes and renders determinations on assigned non-complex grievance and appeal issues and completion of the respective written communication documents to convey the determination
- Serves as a liaison between grievances & appeals and /or medical management, legal, and/or service operations and other internal departments
Skills
Key technologies and capabilities for this role
Questions & Answers
Common questions about this position
Is this a remote position?
This role enables associates to work virtually full-time, with the exception of required in-person training sessions. However, candidates not within a reasonable commuting distance from the posting location(s) will not be considered unless an accommodation is granted.
What are the minimum qualifications for this role?
A high school diploma or GED is required, along with a 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.
What does the Grievance/Appeals Analyst I role involve?
The role reviews, analyzes, and processes non-complex pre-service and post-service grievances and appeals from various customers and products, using guidelines to research claims and medical records, render determinations, and prepare written communications, while following accreditation and regulatory standards.
What preferred skills are mentioned for this position?
Preferred skills include demonstrated business writing proficiency, understanding of provider networks, the medical management process, claims process, the company's internal business processes, and internal local technology.
What salary or compensation is offered for this role?
This information is not specified in the job description.
Elevance Health
Integrated health services and digital platform
About Elevance Health
Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.
Indianapolis, IndianaHeadquarters
1944Year Founded
$309.4MTotal Funding
IPOCompany Stage
Enterprise Software, Social Impact, HealthcareIndustries
10,001+Employees