Anthem, Inc. Manager I Grievance/Appeals in Miami, Florida
SHIFT: Day 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.
Location: Nationwide - Can work from any Anthem office. However, Miami FL, Mason OH, or Wallingford CT is preferred.
The Manager I Grievance/Appeals is responsible for management oversight of grievances and appeals departmental units to investigate, resolve, and respond to client/provider grievances/appeals and ensure compliance with regulatory requirements. Primary duties may include, but are not limited to:
• Maintains and coordinates staff activities to achieve departmental and corporate goals to improve service to customers/providers and assures regulatory compliance.
• Analyzes and develops strategies by achieving performance thresholds within budgetary guidelines.
• Addresses both internal/external customer/provider needs and concerns related to team activities.
• Ensures programs support overall QI program and meet regulatory compliance/accreditation and the company standards.
• Monitors, trends and analyzes grievance and appeals data for submission to appropriate parties.
• Serves as process expert and mentor to unit and other departments for complex issues and interpretation of regulatory standards.
• May perform internal audits of grievance and appeals process.
• Ensures appeals and grievances are resolved within regulatory timeframes.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports
BA/BS in a related field. 3-5 years leadership experience in grievance & appeals, claims or customer service in the healthcare industry or any combination of education and experience that would provide an equivalent background. Bilingual skills preferred (fluent in speaking, reading, and writing both English and another language)
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2019 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.