Grievance / Appeals Analyst I
Posted on: 3 Jan 2021
Cerritos, CA
Job Description
Description
SHIFT: Day Job
SCHEDULE: Full-time
Your innovation. Our impact. At Anthem, Inc., its a powerful combination, and the foundation upon which were creating greater access to care for our members, greater health for our communities, and greater experiences for our customers. Innovation is a top priority. Here, youll have an opportunity to work in a collaborative environment that brings together industry leaders and technology experts, so together we can drive the future of health care.
This is an exceptional opportunity to create solutions and programs that can truly make a difference at one of America's leading health benefits companies and a Fortune Top 50 Company.
Location: Cerritos, CA
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.
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.
Qualifications
Requires a HS diploma or equivalent; 1-3 years experience in health insurance business including customer service experience; or any combination of education and experience, which would provide an equivalent background. Good verbal and written communication, organizational and interpersonal skills. PC proficiency.
Anthem, Inc. is ranked as one of Americas 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
AnEqualOpportunityEmployer/Disability/Veteran
Anthem, Inc.
Indianapolis, IN
Anthem, Inc., through its subsidiaries, operates as a health benefits company in the United States. It operates through three segments: Commercial & Specialty Business, Government Business, and Other. The company offers a spectrum of network-based managed care health benefit plans to large and small group, individual, Medicaid, and Medicare markets. Its managed care plans include preferred provider organizations; health maintenance organizations; point-of-service plans; traditional indemnity plans and other hybrid plans, such as consumer-driven health plans; and hospital only and limited benefit products.
The company also provides a range of managed care services to self-funded customers, including claims processing, underwriting, stop loss insurance, actuarial services, provider network access, medical cost management, disease management, wellness programs, and other administrative services. In addition, it offers an array of specialty and other insurance products and services, such as dental, vision, life and disability insurance benefits, radiology benefit management, and analytics-driven personal health care guidance; and Medicare administrative services.
Further, the company provides services to the federal government in connection with the Federal Employee Program; and operates as a licensee of the Blue Cross and Blue Shield Association. As of December 31, 2018, it served 40 million medical members through its affiliated health plans. The company was formerly known as WellPoint, Inc. and changed its name to Anthem, Inc. in December 2014. Anthem, Inc. was founded in 1944 and is headquartered in Indianapolis, Indiana.
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IndustryHealthcare
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No. of Employees63,900
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Website
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Jobs Posted1634
