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Mgr I Grievance/Appeals (PS2752) in Wallingford, CT at Anthem, Inc.

Date Posted: 3/14/2018

Job Snapshot

  • Employee Type:
  • Job Type:
  • Experience:
    3 to 5 years
  • Date Posted:

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.

If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a 'sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.

This position will be focused on member grievances.

Responsible for management oversight of receipt, investigation and processing associated with member/provider grievance and appeals.

Primary duties may include, but are not limited to:

  • Monitors, trends and analyzes grievance and appeals data for submission to appropriate parties.
  • Serves as resource/expert and mentor to unit and other departments for complex issues and interpretation of regulatory standards.
  • Performs internal monitoring and oversight of grievance and appeals cases and process.
  • Ensures appeals and grievances are resolved within regulatory timeframes.
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Job Requirements

Requires 3-5 years leadershipexperience in grievance & appeals, claims or customer services in thehealthcare industry; 3-5 years’ Medicare experience; exceptionaloral and written communication skills, proven success in staff and teamdevelopment, demonstrated strength in the following:  use of Microsoftoffice suite of tools (word, excel, ppt), use/understanding of data bases andcase processing platforms;  and or anycombination of education and experience, which would provide an equivalentbackground. BA/BS preferred.

Anthem, Inc. is ranked as one of America’sMost Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityIncmagazine Top 50 Company for Diversity. To learn more about our company andapply, please visit us at EOE. M/F/Disability/Veteran.