Get new similar jobs by email for

Grievance/Appeals Rep Lead - M...


Job Summary

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

Grievance/Appeals Rep Lead - Mason, OH (PS4758)

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 Rep Lead - Mason, OH

The Grievance/Appeals Rep Lead will be responsible for conducting compliance audits on senior Grievance/Appeals Reps and below. Primary duties may include, but are not limited to:

  • Coaches Grievance/Appeals Reps to achieve quality and timeliness standards and monitors all case handling to ensure consistency and accuracy
  • Facilitates second level panel meetings
  • Acts as the liaison with the Legal Department
  • Performs appeals analysis/trending and pursues recommendations for corrective actions to reduce the number of appeals and/or improve the timeliness of appeal resolution
  • Develops training materials and conducts one on one as well as group training
  • Oversees Grievance/Appeals accreditation compliance and compliance with regulations in 51 jurisdictions

  • Requires a HS Diploma or equivalent
  • 3 + years progressively complex experience working in grievances and appeals
  • 3+ years experience in a healthcare and/or insurance work environment
  • Deep understanding of the application of benefits contracts, pricing, policies and legislative regulations
  • OR any combination of education and experience which would provide an equivalent background
  • Excellent verbal and written communication skills, organizational skills, and interpersonal skills
  • Computer skills in MS Outlook, Excel, and Word, with the ability to work on several software programs simultaneously
  • Desire to work in a team lead role
  • Able to work in-office in Mason, OH
  • Able to work M-F, 8 hour shift between 9am - 6pm and work from home every other Saturday for 4 hours

Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2015 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.

Job Tools