Grievance/Appeals Representative II

Company: Elevance Health
Location: Jefferson City
Posted on: September 15, 2023

Job Description:

WARNING: Please beware of phishing scams that solicit interviews or promote work-at-home opportunities, some of which may pose as legitimate companies. Elevance Health requires a completed online application for consideration of employment for any position. We will never ask you for a credit card, send you a check, or ask you for payment as part of consideration for employment.
**Grievance/Appeals Representative II**
+ Job Family: Claims
+ Type: Full time
+ Date Posted:Jun 07, 2023
+ Req #: JR74092
**Location:**
+ VA, NORFOLK
+ National +50 Miles away from nearest PulsePoint
**Description**
**Title: Grievance/Appeals Representative II**
**Sign-on Bonus: $500**
**Location:** This position will work in a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.
**Grievance/Appeals Representative II** is 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.
**Minimum Requirements:**
+ HS diploma or equivalent
+ 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 Experiences:**
+ 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 below locations, the salary* range for this specific position is $18.04 to $32.47
**Locations:** California; Colorado; Nevada; Washington State; Jersey City, NJ; New York City, NY; Ithaca, NY and Westchester County, NY
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 remains in the Company's sole discretion unless and until paid and may be modified at the Companys sole discretion, consistent with the law.
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. A Fortune 20 company with a longstanding history in the healthcare industry, 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.
Elevance Health operates in a Hybrid Workforce Strategy, providing various levels of flexibility while also ensuring that associates have opportunities to connect in-person. Unless in a designated virtual-eligible role and specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles 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 2022, has been ranked for five years running as one of the 2023 Worlds Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. 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.
EEO is the Law
Equal Opportunity Employer / Disability / Veteran
Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.
+ EEO Policy Statement
+ Know Your Rights
+ Pay Transparency
+ Privacy Notice for California Residents
Elevance Health, Inc. is anE-verify Employer (https://www.e-verify.gov/sites/default/files/everify/posters/EVerifyParticipationPoster.pdf)
Need Assistance?
Email us (elevancehealth@icareerhelp.com) or call 1-877-204-7664

Keywords: Elevance Health, Jefferson City , Grievance/Appeals Representative II, Other , Jefferson City, Missouri