at Anthem, Inc in Wilmington, Delaware, United States
DescriptionSHIFT: Day Job
SCHEDULE: Full-time*$500 Sign-On Bonus* Grievance/Appeals Analyst Lead United States Be part of an extraordinary team. We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact? Responsible for leading and coaching a team of Grievance & Appeals Analysts in the Enterprise Grievance & Appeals Department responsible to review, analyze and process preservice and post service grievances and appeals requests related to clinical and non-clinical services, quality of service and quality of care issues to include executive and regulatory grievances. Primary duties may include, but are not limited to:
+ Monitors workflow and makes assignments to ensure the correct team resource is utilized to achieve accreditation and regulatory compliance metrics in a quality manner.
+ May also be responsible to provide review and analysis of complex preservice and post service grievances and appeals requests from customer and multiple products related to clinical and non-clinical services, quality of service, and quality of care issues to include executive and regulatory grievances.
+ Coaches, trains, and audits to ensure the team correctly utilizes guidelines and review tools to conduct extensive research, analyze the grievance, and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route to nursing and/or medical staff for review.
+ HS diploma or equivalent
+ Minimum of 3 years of Grievance & Appeals Senior analyst experience; or any combination of education and experience which would provide an equivalent background.Preferred:
+ Associate’s or BA/BS degree preferred.For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. 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. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state, and local laws. Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact firstname.lastname@example.org for assistance. REQNUMBER: PS72769