Grievance/Appeals Representative I

divh2Grievance/Appeals Representative I/h2pThis 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. Alternate locations may be considered if candidates reside within a commuting distance from an office./ppThe Grievance/Appeals Representative I is responsible for reviewing, analyzing and processing member complaints in accordance with policies and claims events to determine the extent of the companys liability and entitlement./ppHow you will make an impact:/pulliConducts investigation and review of customer grievances and appeals involving provision of service and benefit coverage issues./liliContacts customers to gather information and communicate disposition of case; documents interactions./liliGenerates written correspondence to customers such as members, providers and regulatory agencies./liliPerforms research to respond to inquiries and interprets policy provisions to determine the extent of companys liability and/or providers/beneficiaries entitlement./liliResponds to appeals from CS Units, Provider Inquiry Units, members, providers and/or others for resolution or affirmation of previously processed claims./liliEnsures appropriate resolution to inquiries, grievances and appeals within specified timeframes established by either regulatory/accreditation agencies or customer needs./liliIdentifies barriers to customer satisfaction and recommends actions to address operational challenges./li/ulpMinimum Requirements:/pulliHS diploma or equivalent/liliMinimum of 1 year experience in health insurance business including customer service experience; or any combination of education and experience which would provide an equivalent background./li/ulpPreferred Skills, Capabilities and Experiences:/pulliGood verbal and written communication, organizational, interpersonal skills and PC proficiency strongly preferred./li/ulpFor 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./ppLocations: Massachusetts/ppIn 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./pp* 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 Companys sole discretion unless and until paid and may be modified at the Companys sole discretion, consistent with the law./ppElevance 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 spanelevancehealthjobssupport@elevancehealth.com/span for assistance./p/div