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Grievance & Appeals Representative I- Miami FL, PS15347 in Miami, FL at Anthem, Inc.

Date Posted: 12/5/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Miami, FL
  • Job Type:
  • Experience:
    1 to 3 years
  • Date Posted:
    12/5/2018

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 Representative I:
 
Responsible for reviewing, analyzing and processing claims 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.

Requirements: 
  • High school diploma or equivalent;
  • 1-3 years 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.
  • Bilingual English/Spanish preferred.
  • Managed care experience preferred.
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 careers.antheminc.com An Equal Opportunity Employer/Disability/Veteran