Anthem, Inc. Grievance/Appeals Rep I in Walnut Creek, California
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 care companies and a Fortune Top 50 Company.
The Grievance/Appeals Representative I position is responsible for reviewing, analyzing and processing grievance and appeals requests in accordance with policies and claims events to determine the extent of the company's liability and entitlement.
Primary duties may include, but are not limited to:
Conducts investigation and review of customer grievances and appeals involving provision of service and benefit coverage issues.
Contacts customers to gather information and communicate disposition of case; documents interactions.
Generates written correspondence to customers such as members, providers and regulatory agencies.
Performs research to respond to inquiries and interprets policy provisions to determine the extent of company's liability and/or provider's/beneficiaries entitlement.
Responds to appeals from CS Units, Provider Inquiry Units, members, providers and/or others for resolution or affirmation of previously processed claims. Ensures appropriate resolution to inquiries, grievances and appeals within specified timeframes established by either regulatory/accreditation agencies or customer needs.
Identifies barriers to customer satisfaction and recommends actions to address operational challenges.
Requires a HS diploma or equivalent; 1-3 years of experience in health insurance business including customer service experience; or any combination of education and experience, which would provide an equivalent background. Good verbal and written communication, organizational and interpersonal skills. PC proficiency.
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 please visit us at antheminc.com/careers. AnEqualOpportunityEmployer/Disability/Veteran