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 are the shift hours for this position?
The shift hours are Monday through Friday from 8:30am to 5:00pm EST.
What salary or compensation does this role offer?
This information is not specified in the job description.
What skills make a strong candidate for this position?
Preferred candidates have demonstrated business writing proficiency, understanding of provider networks, the medical management process, and the claims process.
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