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Anthem, Inc. Grievance/Appeals Analyst Lead in Miami Lakes, Florida

Description

SHIFT: Day Job

SCHEDULE: Full-time

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 care companies and a Fortune Top 50 Company.

The Grievance/Appeals Analyst Lead is responsible for leading and coaching a team of Grievance & Appeals Analysts in the Enterprise Grievance & Appeals Department responsible to review, analyze and process pre service and post service grievances and appeals requests related to clinical and non clinical services, quality of service and quality of care issues to include executive and regulatory grievances.

Primary duties may include, but are not limited to:

  • Monitors work flow and makes assignments to ensure the correct team resource is utilized to achieve accreditation and regulatory compliance metrics in a quality manner.

  • May also be responsible to provide review and analysis of complex pre service and post service grievances and appeals requests from customer and multiple products related to clinical and non clinical services, quality of service, and quality of care issues to include executive and regulatory grievances.

  • Coaches, trains, and audits to ensure the team correctly utilizes guidelines and review tools to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route to nursing and/or medical staff for review.

Qualifications

Qualifications:

  • Requires a High School diploma or GED equivalent from an accredited institution.

  • 3 to 5 years of Grievance & Appeals Senior analyst experience; or any combination of education and experience, which would provide an equivalent background.

  • Associate's or BA/BS degree preferred.

  • For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

    We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

    REQNUMBER: PS48343

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