🌎
This job posting isn't available in all website languages

Settings

Grievance/Appeals Representative I - Mason, OH - PS15281

📁
Claims
📅
PS15281 Requisition #
Apply for Job
Share this Job
Sign Up for Job Alerts
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.

Grievance/Appeals Representative I

This is a dedicated representative for the Complaints Tracking Module (CTM) Department.
Responsible for reviewing,analytical research, root cause analysis, and resolution of complaints received by Centers for Medicare/Medicaid Services (CMS) in accordance with policies and procedures of the department
Primary duties may include, but are not limited to: 
  • Conducts research and review of member/provider complaints involving but not limited to provision of service and benefit

    coverage issues.

  • Contacts members/providers 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.

  • Ensures appropriate resolution to complaints within specified time frames established by CMS and/or CTM Management.

  • Identifies barriers to members/providers satisfaction and recommends actions to address operational challenges.

  • High School diploma or GED required;

  • 1+ years experience in Medicare health insurance business including customer service and complaints resolution experience;

  • Or any combination of education and experience, which would provide an equivalent background.

  • Strong oral, verbal and written communication, organizational, time management, and interpersonal skills.

  • Strong analytical skills and root cause analysis skills.

  • Intermediate PC proficiency required.

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 and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

My Profile

Create and manage profiles for future opportunities.

Go to Profile

My Submissions

Track your opportunities.

My Submissions

Similar Listings

New Haven, Connecticut, United States

📁 Claims

Requisition #: PS14524

Mason, Ohio, United States

📁 Claims

Requisition #: PS15275

New Haven, Connecticut, United States

📁 Claims

Requisition #: PS12581

Career Areas

At Anthem, Inc., there are many ways to make a difference. Here, the skills and passions of thousands come together, creating an impressive force with the power to change lives and the future of health care.

 

Actuarial

Contribute to analysis that impacts the financial future and well-being of our stakeholders, customers and the health care industry.

Read More

Find a Career

Administrative and
 Business Support

Use your exceptional organizational and interpersonal skills to help ensure the consistent, quality-driven performance of a consumer-centric industry leader.

Read More

Administrative Careers

Business Support Careers

 
 

Business Development and Sales

Be the embodiment of our "Easy-to-do Business With" Value, by treating our customers the way you would want to be treated and providing simple solutions that are easy to understand.

Read More

Business Development Careers

Sales Careers

Communications and Marketing

Lead the development of new messaging, products and innovations that continuously improve the value of our offerings to customers.

Read More

Communications Careers

Marketing Careers

 
 

Customer Care

Become the ultimate customer advocate. Share your expertise and help customers maximize the value of the tools and resources we provide.

Read More

Find a Career

Digital Transformation and Enablement

If you are eager to develop innovative digital products in healthcare and make a difference in people's lives, join our Digital organization and help us change the face of healthcare together.

Read More

Digital Solutions Careers

Digital Technologies Careers

 
 

Finance

Bolster the strategic objectives of a Fortune 50 industry leader, while supporting the tenet of financial integrity that is fundamental to Anthem, Inc.'s Purpose, Vision and Values.

Read More

Find a Career

Health Care Analytics

Provide strategic analysis that impacts business decisions, improves efficiency and drives innovation.

Read More

Find a Career

 
 

Human Resources

Lead our workforce and workplace talent strategies, to accomplish our vision to be recognized as America’s valued health partner.

Read More

Find a Career

Information Technology

Lead our workforce and workplace talent strategies, to accomplish our vision to be recognized as America's valued health partner.

Read More

Find a Career

 
 

Metrics & Data

Leverage your talents to make a difference in people's lives, by providing innovative, data-driven solutions that can measure and track progress in our members' health.

Read More

Find a Career

Medical

Drive the future of health care, by helping us improve health outcomes and quality of life for our associates, members and communities.

Read More

Find a Career

Underwriting

Work in areas of specialty as varied as Life & Disability Underwriting, Pre-Sales, Retention and Implementation, Risk Analysis and Medical Evidence Underwriting.

Read More

Find a Career

Operations

Stretch your analytic problem-solving skills while working on enterprise-level projects and cross-functional teams.

Read More

Find a Career

View All Jobs

Temporary Contract Opportunities

Associate
 Benefits

At Anthem, we’re in the business of taking care of people. In fact, everything we do is aimed at creating positive outcomes that make a difference in peoples’ lives, which of course includes our family of associates.

Learn More

Student Programs

Anthem continues to demonstrate the kind of visionary leadership needed to drive the future of health care. Our efforts and accomplishments have been recognized by numerous leading publications and organizations.

Learn More

Military and
 Veteran Careers

As one of America’s largest health benefits companies, we have a profound appreciation for service. Our organization proudly supports our nation’s active, reserve and veteran military service members and their spouses.

Learn More

Why Choose Anthem

Why is Anthem a respected industry leader? Our standards are high – for the service we provide our members and the support we show our associates. Every day, we answer the call – to do the right thing and to treat others with respect. This is the sense of purpose that leads Anthem to thrive, and which will ensure our future success, and yours.

 

Life at Anthem

How often do you get the chance to do something truly life-changing? If you work with us the answer is ... every day. Our determination to drive the future of health care is ambitious, but so are our people.

Learn More

Diversity & Inclusion

Diversity and inclusion play a major role in our success, because it’s more than just a philosophy to us, it drives our power to innovate. From our corporate culture and strategic partnerships, to our commitment to our associates, our customers and communities, diversity is foundational in everything we do.

Learn More