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Anthem Grievance/Appeals Audit Specialist - Eastern Region, US - PS22944 in Arlington, Texas

Grievance/Appeals Audit Specialist - Eastern Region, US - PS22944

Location: United States


Requisition #: PS22944

Post Date: 4 days ago

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.

This position requires that you have audit experience. You will receive the equipment and training to work from a home office. You must have a high speed internet connection. You may live in any eastern time zone state to support the eastern region QM dept.

The Grievances/Appeals Audit Specialist is responsible for Commercial Grievances & Appeals audit preparation activities that include the presentation of case specifics to the external entity auditing Anthem.

Primary duties to include, but are not limited to:

Manage and oversee external audit requests and delegated entity functions for Grievance & Appeals.

Interpret audit requests and prepare comprehensive responses.

Support and participate in planning, executing, and facilitating audits/audit requirements.

Based on audit findings/review participate in root cause analysis, process improvement and communication activities on behalf of G&A.

Requires bachelor's degree and 2+ years related experience, or equivalent combination of education and experience.

-Audit experience required.

-Experience with Medicaid, QM, Grievances/Appeals and/or the health insurance industry preferred.

-Good analytical and problem-solving skills required.

-Excellent oral and written communication skills necessary.

-Strong organizational skills also required.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at

An Equal Opportunity Employer/Disability/Veteran