Mgr I Grievance/Appeals

at Anthem, Inc in Wilmington, Delaware, United States

Job Description


SHIFT: Day Job

SCHEDULE: Full-time

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 position of Mgr I Grievance/Appeals is responsible for the management and oversight of receipts, 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 clinical resource expert and mentor to the unit and other departments for complex issues and interpretation of regulatory standards.

+ May perform internal audits of grievance and appeals process.

+ Ensures appeals and grievances are resolved within regulatory timeframes.

+ Hires, trains, coaches, counsels, and evaluates the performance of direct reports.

Minimum Qualifications:

+ Requires a minimum of 3 years leadership experience in grievance & appeals, claims or customer services in the healthcare industry; or any combination of education and experience which would provide an equivalent background.

+ Ability to travel may be required

+ For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.


Preferred Qualifications:

+ health care, regulatory, ethics, compliance or privacy experience; or any combination of education and/or experience preferred.

+ BA/BS preferred.

+ Critical Thinking & Root cause analysis techniques a plus

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. Applicable to Colorado Applicants Only Annual Salary Range*: $80,900 – $97,080 Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
  • The hourly or salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company’s sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. An Equal Opportunity Employer/Disability/Veteran. Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions. REQNUMBER: PS58992-US
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Job Posting: JC192467464

Posted On: Sep 16, 2021

Updated On: Sep 30, 2021