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Anthem, Inc. Grievance/Appeals Analyst Senior in La Mirada, California

Description

SHIFT: Day Job

SCHEDULE: Full-time

Be part of an extraordinary team

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Build the Possibilities. Make an extraordinary impact.

  • This is a remote, work from home position.

  • Must be located in the state of California

    How you will make an impact:

    Responsible for reviewing, analyzing, and processing complex pre service and post service grievances and appeals requests in the Enterprise Grievance & Appeals Department and the completion of written communication documents to convey the determination. Primary duties may include, but are not limited to:

  • Represents the highest level of expertise that is required to respond to regulators, media inquiries, member and provider issues escalated to the Executive Leadership Team (ELT) and regulatory agencies.

  • Researches and makes determinations on complex appeals or grievances that come from a variety of sources including the state/federal regulators, members, media, attorneys representing members and inquiries received from any of these sources.

  • This includes reviewing and extrapolating member Evidence of Coverage language for interpretation where ambiguity may exists and initiates a recommendation to Contracts and/or Legal.

  • Works with the Legal Department on various types of cases such as pleadings received from the various regulators, actions and violations and with Public Relations and Government Relations on research and resolution of media issues.

Qualifications

Minimum Requirements:

  • High school diploma or GED equivalent

  • Minimum of 3 years of Grievance & Appeals Analyst experience and a minimum of 3 years experience working in grievances and appeals, claims, or customer service; or any combination of education and experience which would provide an equivalent background.

    Preferred Skills, Capabilities and Experiences:

  • Associates degree preferred.

  • For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have 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. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. 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. Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

    REQNUMBER: PS71330

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