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Grievance/Appeals Analyst Ld--...


Job Summary

Wallingford, CT
Other/Not Classified
Job Type
Full Time
Career Level
Experienced (Non-Manager)
Job Reference Code

Grievance/Appeals Analyst Ld-- Mason OH or Wallingford, CT (PS2704)

About the Job

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 Analyst Lead - Mason, OH or Wallingford, CT

This position is responsible for leading and coaching a team of Grievance & Appeals Analysts, and they review, analyze and process 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 business and regulatory compliance metrics in a quality manner
  • May also be responsible for providing review and analysis of complex 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, monitors, and audits to ensure the team correctly utilizes guidelines and review tools to conduct extensive research and analyze the grievance and appeal issue(s)
  • Requires HS Diploma or equivalent, Associate's or BA/BS degree preferred

  • 3+ years of Grievance & Appeals Analyst experience

  • 3+ years of Medicare operations experience
  • Strong oral and written communications skills
  • Proficient computer skills such as MS Outlook, Excel and Word
  • 1+ years of leadership experience
  • Or any combination of education and experience, which would provide an equivalent background

Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.

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