Responsible for reviewing, analyzing and processing grievances in accordance with policies.
Primary duties may include, but are not limited to:
* Conducts investigation and review of customer grievances and appeals involving provision of service and benefit coverage issues.
* Contacts customers to gather information and communicate disposition of case; documents interactions.
* Generates written correspondence to customers such as members, providers and regulatory agencies.
* Performs research to respond to inquiries and interprets policy provisions to determine the extent of company’s liability and/or provider’s/beneficiaries entitlement.
* Responds to appeals from CS Units, Provider Inquiry Units, members, providers and/or others for resolution or affirmation of previously processed claims.
* Ensures appropriate resolution to inquiries, grievances and appeals within specified timeframes established by either regulatory/accreditation agencies or customer needs.
* Identifies barriers to customer satisfaction and recommends actions to address operational challenges.
* 1-3 years experience in health insurance business including customer service experience
* Any combination of education and experience, which would provide an equivalent background
* Good verbal and written communication, organizational and interpersonal skills
* Managed Care experience required
*WARNING : Please beware of phishing scams that promote work-at-home opportunities and which may also pose as legitimate companies. Please be advised that an Anthem recruiter 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 a role with our company. All of our careers require that you first complete an online application.