Elevance Health
Grievance/Appeals Representative I
Locations:
Woburn, MA and Manchester, NH
This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.
How you will make an impact
Conduct investigation and review of customer grievances and appeals involving provision of service and benefit coverage issues.
Contact customers to gather information and communicate disposition of case; document interactions.
Generate written correspondence to customers such as members, providers and regulatory agencies.
Perform research to respond to inquiries and interpret policy provisions to determine the extent of company's liability and/or provider's/beneficiary's entitlement.
Respond to appeals from CS Units, Provider Inquiry Units, members, providers and/or others for resolution or affirmation of previously processed claims.
Ensure appropriate resolution to inquiries, grievances and appeals within specified timeframes established by either regulatory/accreditation agencies or customer needs.
Identify barriers to customer satisfaction and recommend actions to address operational challenges.
Minimum Requirements
High school diploma or equivalent.
Minimum of 1 year experience in health insurance business including customer service experience; or any combination of education and experience providing an equivalent background.
Preferred Skills, Capabilities and Experiences
Good verbal and written communication, organizational, interpersonal skills and PC proficiency strongly preferred.
For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $21.11/hr to $31.67/hr.
Benefits include a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401(k) contribution.
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 elevancehealthjobssupport@elevancehealth.com for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
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Woburn, MA and Manchester, NH
This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.
How you will make an impact
Conduct investigation and review of customer grievances and appeals involving provision of service and benefit coverage issues.
Contact customers to gather information and communicate disposition of case; document interactions.
Generate written correspondence to customers such as members, providers and regulatory agencies.
Perform research to respond to inquiries and interpret policy provisions to determine the extent of company's liability and/or provider's/beneficiary's entitlement.
Respond to appeals from CS Units, Provider Inquiry Units, members, providers and/or others for resolution or affirmation of previously processed claims.
Ensure appropriate resolution to inquiries, grievances and appeals within specified timeframes established by either regulatory/accreditation agencies or customer needs.
Identify barriers to customer satisfaction and recommend actions to address operational challenges.
Minimum Requirements
High school diploma or equivalent.
Minimum of 1 year experience in health insurance business including customer service experience; or any combination of education and experience providing an equivalent background.
Preferred Skills, Capabilities and Experiences
Good verbal and written communication, organizational, interpersonal skills and PC proficiency strongly preferred.
For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $21.11/hr to $31.67/hr.
Benefits include a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401(k) contribution.
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 elevancehealthjobssupport@elevancehealth.com for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
#J-18808-Ljbffr