Anthem, Inc. Grievance/Appeals Representative I in Ocala, Florida
SHIFT: Day Job
Your Talent. Our Vision. At America’s First Choice, a proud member of the Anthem, Inc. family of companies, 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.
Hours/Location: Currently work at home but will be transitioning to a hybrid work model (TBD 2022- days in office will range from 3-20 days per quarter. Flexible schedule post training- must work 8 hours a day between the hours of (7:30am-9:30pm EST). Must live within 50 miles of the Tampa office.Due to the current COVID-19 (coronavirus) pandemic, this position will require you to work remotely from your home with the flexibility to return to a regular, in-office work environment. As we continue to monitor guidance from CDC and state officials there may be times you would need to report to the office on a monthly or quarterly basis for team meetings or engagement activities.
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
The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against Covid-19. All offers of employment are conditioned on completion of a background check, including COVID-19 vaccination verification. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.
Requires a High School diploma or GED equivalent
A minimum of 1 year experience in health insurance business including customer service experience
Good verbal and written communication, organizational, interpersonal skills and PC proficiency preferred
1 year of coding experience or coding certificate preferred
Microsoft Office Suite knowledge preferred
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.