Grievance/Appeals Analyst I
Company: Anthem, Inc.
Location: New Haven
Posted on: February 22, 2021
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Job Description:
Welcome to the Anthem Careers site! We have been hard at work to
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Job Family: Claims
Req #: PS41282-Wallingford
Date Posted: Jan 16, 2021 Location: Mason OH or Wallingford CT
Office Your innovation. Our impact.--At--Anthem, Inc., it's a
powerful combination, and the foundation upon which we're creating
greater access to care for our members, greater health for our
communities, and greater experiences for our customers. Innovation
is a top priority.--Here, you'll have an opportunity to work in a
collaborative environment that brings together industry leaders and
technology experts, so together we can--drive the future of health
care. This is an entry level position in the Enterprise Grievance &
Appeals Department that reviews, analyzes and processes non-complex
pre service and post service grievances and appeals requests from
customer types (i.e. member, provider, regulatory and third party)
and multiple products (i.e. HMO, POS, PPO, EPO, CDHP, and
indemnity) related to clinical and non clinical services, quality
of service, and quality of care issues to include executive and
regulatory grievances. Primary duties may include, but are not
limited to: 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. The grievance
and appeal work is subject to applicable accreditation and
regulatory standards and requirements. As such, the analyst will
strictly follow department guidelines and tools to conduct their
reviews. The file review components of the URAC and NCQA
accreditations are must pass items to achieve the accreditation.
Analyzes and renders determinations on assigned non-complex
grievance and appeal issues and completion of the respective
written communication documents to convey the determination.
Responsibilities exclude conducting any utilization or medical
management review activities which require the interpretation of
clinical information. The analyst may serve as a liaison between
grievances & appeals and /or medical management, legal, and/or
service operations and other internal departments. Qualifications
Requires a High school diploma or GED; 3 to 5 years experience
working in grievances and appeals, claims, or customer service,
familiarity with medical coding and medical terminology,
demonstrated business writing proficiency, understanding of
provider networks, the medical management process, claims process,
the company's internal business processes, and internal local
technology; or any combination of education and/or experience which
would provide an equivalent background. For URAC accredited areas
the following applies: Requires strong oral, written and
interpersonal communication skills, problem-solving skills,
facilitation skills, and analytical skills.
Anthem, Inc. is ranked as one of America's Most Admired Companies
among health insurers by Fortune magazine, and is a 2018
DiversityInc magazine Top 50 Company for Diversity. To learn more
about our company please visit us at antheminc.com/careers.
AnEqualOpportunityEmployer/Disability/Veteran 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 Analyst I, Professions , New Haven, Connecticut
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