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Grievance & Appeals Auditor I

Company: Anthem, Inc.
Location: New Haven
Posted on: April 10, 2021

Job Description:

Welcome to the Anthem Careers site! We have been hard at work to improve our job search and application systems to better serve you. It is now easier to find and apply for relevant jobs as well as stay connected with Anthem. Here are a few of the updates you may notice: Welcome to the Anthem Careers site! We have been hard at work to improve our job search and application systems to better serve you. It is now easier to find and apply for relevant jobs as well as stay connected with Anthem. Here are a few of the updates you may notice:

  • No more profiles! We no longer require you to create a log in and password to apply for a job and you won't be able to access previously created profiles, but don't worry - we still have your previous application(s) on file and you can still track your status by clicking on the "Track Your Job Application Status" button.
  • Job Alerts - If you had previously registered to receive job alerts and wish to continue to receive these notifications, please re-register by clicking the "job alert" button.
  • NEW! Didn't find a job that is right for you? Join a Talent Network to stay informed on news and job opportunities with the Anthem Team! It is important that you apply using an email address which is unique to you and not shared with a friend, relative, spouse, or significant other. Our recruiting system uses your email address as your unique identifier. If you apply with a shared email address, your application will overwrite any previous applicant record with the same email address. Additionally, please ensure that you use a valid email address, free from typos, as there are a variety of communications which may be sent to the email address with which you apply Grievance & Appeals Auditor I Location: New Haven, CT
    Job Family: Quality
    Req #: PS46631
    Date Posted: Apr 6, 2021 Your Talent. Our Vision. At Anthem, Inc., it's a powerful combination, and the foundation upon which we're creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care. This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health care companies and a Fortune Top 50 Company. Responsibilities: Responsible for post completion examination of grievances and appeals in multiple states. Primary duties may include, but are not limited to: Reviews case to determine applicability of, and compliance with, federal and state regulations, enterprise policies and procedures and all related accreditation standards. Reviews case to assess whether it was appropriately handled as a clinical or administrative request and was correctly processed to avoid prompt pay penalties. Evaluates urgency of clinical situation to assess appropriate handling, determine if sufficient records were obtained, and review medical records and medical policies to determine if correct criterion has been utilized in each review. Reviews case documentation to assess appropriate system entries have been made and that the step-by-step process is sufficient to mitigate risk associated with regulatory reviews, accreditation reviews, and potential litigation. Assists management in process improvement strategies to achieve business objectives. Prepares audit findings and recommendations for G&A associates and management on a monthly basis. Identifies and communicates error trends to improve overall quality of enterprise G&A team. Associates at this level handle routine audits and may receive guidance from G&A Auditor IIs. Qualifications Requires a BA/BS degree, a minimum of 1 year of grievance and appeals experience; or any combination of education and experience which would provide an equivalent background.

    What we offer: 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.

    Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions. Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem. Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem. EEO is the Law Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees. Anthem, Inc. is committed to helping individuals with disabilities participate in the workforce and ensuring equal opportunity to apply and compete for jobs. If you are an individual with a disability and require a reasonable accommodation to complete the application process, please email Human Resources at ability@icareerhelp.com for further assistance. *WARNING : Please beware of phishing scams that solicit interviews or promote work-at-home opportunities, some of which may pose as legitimate companies. Please be advised that Anthem will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission here by selecting the 'Rip-offs and Imposter Scams' option. Anthem requires a completed online application for consideration of employment for any position.

Keywords: Anthem, Inc., New Haven , Grievance & Appeals Auditor I, Accounting, Auditing , New Haven, Connecticut

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