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Grievance/Appeals Analyst Lead - Mason, OH - PS15280 in Mason, OH at Anthem, Inc.

Date Posted: 12/3/2018

Job Snapshot

Job Description

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 Analyst Lead

Responsible for leading and coaching the Complaint Tracking Modules (CTM) representatives in the CTM Department. Responsible to review, analyze and trend complaints that are assigned to plan by Center for Medicaid and Medicare (CMS). Responsible for assisting and supporting to meet all CTM performance metrics.

Primary duties may include, but are not limited to:
  • Monitors work flow and makes assignments to ensure the correct team resource is utilized to achieve timeliness and
  • regulatory compliance metrics in a quality manner.
  • Responsible to provide review, response and analyze complex complaints.
  • Coaches, trains, and audits CTM Reps to ensure the team correctly utilizes CMS and DLP guidelines. 
  • Reviews CTM Tool to conduct extensive research and analysis for complaints, issues, and trends.
  • Serves as first line defense for Supervisor calls and/or escalations
  • Responsible for data tracking and analysis

  • Requires a HS diploma or equivalent; 
  • 2 to 5 years of complaints analysis experience; or any combination of education and experience, which would provide an equivalent background. 
  • Associate's or BA/BS degree preferred.
  • At least 1 year management experience preferred. 
  • Knowledge of Microsoft Word and Excel is 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.