Grievance/Appeals Representative I
Elevance Health, Atlanta, GA, United States
Grievance/Appeals Representative I
Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.
According to company policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
The Grievance/Appeals Representative I is responsible for reviewing, analyzing and processing claims in accordance with policies and claims events to determine the extent of the company's liability and entitlement.
How you will make an impact
Conduct investigations 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
HS diploma or equivalent.
Minimum 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.
Preferred Skills, Capabilities and Experiences
Good verbal and written communication, organizational, interpersonal skills and PC proficiency strongly preferred.
In 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.
Locations: New York
Salary range: $19.55/hr to $29.32/hr.
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.
Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration (https://info.flclearinghouse.com/).
#J-18808-Ljbffr
According to company policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
The Grievance/Appeals Representative I is responsible for reviewing, analyzing and processing claims in accordance with policies and claims events to determine the extent of the company's liability and entitlement.
How you will make an impact
Conduct investigations 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
HS diploma or equivalent.
Minimum 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.
Preferred Skills, Capabilities and Experiences
Good verbal and written communication, organizational, interpersonal skills and PC proficiency strongly preferred.
In 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.
Locations: New York
Salary range: $19.55/hr to $29.32/hr.
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.
Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration (https://info.flclearinghouse.com/).
#J-18808-Ljbffr