Grievance/appeals Representative Ii - Woburn, United States - Elevance Health

Elevance Health

Verified Company

Woburn, United States

3 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

Job Family:
CLM > Claims Support

Type: Full time
Date Posted: Apr 24, 202
Anticipated End Date: May 23, 2024
Reference: JR110934

Description:

Grievance/Appeals Representative II

Location:
Hybrid 500 Unicorn Park Drive Woburn, MA

The
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 nonclinical 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 nonclinical 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:

Requires a 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 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.

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.