Anthem Inc. Indianapolis Jobs

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Anthem, Inc. Grievance/Appeals Analyst I/II in Indianapolis, Indiana

Description

SHIFT: Day Job

SCHEDULE: Full-time

Grievance/Appeals Analyst I/II United States-Remote

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?

Build the Possibilities. Make an extraordinary impact.

$500 Sign On Bonus

Applicable to Colorado Applicants Only Annual Salary Range: $40,032- $50,040 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.

Grievance/Appeals Analyst I is responsible for reviewing, analyzing and processing non-complex and some complex pre service and post service grievances and appeals requests in the Enterprise Grievance & Appeals Department from customer types (i.e. member, provider, regulatory, and third party) and multiple products (i.e. HMO, POS, PPO, EPO, CDHP, and indemnity) 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:

  • Utilizes guidelines and review tools to conduct extensive research and 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

  • The grievance and appeal work is subject to applicable accreditation and regulatory standards and requirements

  • As such, the analyst will strictly follow department guidelines and tools to conduct their reviews, and completion of the respective written communication documents to convey the determination

  • The file review components of the URAC and NCQA accreditations are must pass items to achieve the accreditation

  • The analyst may serve as a liaison between grievances & appeals and /or medical management, legal, and/or service operations and other internal departments

  • Obtaining cooperation from these other areas requires an awareness of their functions and necessitates the development and maintenance of relationships to include instilling an awareness of our customer expectations and responses

  • Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information

  • Identify opportunities for improvement and any provide support and assistance to G & A Analyst I associates as needed

    Grievance/Appeals Analyst II is responsible for reviewing, analyzing and processing non-complex and some complex pre service and post service grievances and appeals requests in the Enterprise Grievance & Appeals Department from customer types (i.e. member, provider, regulatory, and third party) and multiple products (i.e. HMO, POS, PPO, EPO, CDHP, and indemnity) 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:

  • Utilizes guidelines and review tools to conduct extensive research and 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

  • The grievance and appeal work is subject to applicable accreditation and regulatory standards and requirements

  • As such, the analyst will strictly follow department guidelines and tools to conduct their reviews, and completion of the respective written communication documents to convey the determination

  • The file review components of the URAC and NCQA accreditations are must pass items to achieve the accreditation

  • The analyst may serve as a liaison between grievances & appeals and /or medical management, legal, and/or service operations and other internal departments

  • Obtaining cooperation from these other areas requires an awareness of their functions and necessitates the development and maintenance of relationships to include instilling an awareness of our customer expectations and responses

  • Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information

  • Identify opportunities for improvement and any provide support and assistance to G & A Analyst I associates as needed

Qualifications

Required qualifications Grievance/Appeals Analyst I:

  • HS diploma or equivalent

  • Minimum of 3 years experience working in grievances and appeals, claims, or customer service; or any combination of education and experience which would provide an equivalent background

    Preferred qualifications Grievance/Appeals Analyst I:

  • Associates 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.

    Required qualifications Grievance/Appeals Analyst II:

  • HS diploma or equivalent

  • Minimum of 1 year of Grievance & Appeals analyst experience

  • Minimum of 3 years experience working in grievances and appeals, claims, or customer service; or any combination of education and experience which would provide an equivalent background

    Preferred qualifications Grievance/Appeals Analyst II:

  • Associates 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 ability@icareerhelp.com for assistance.

    REQNUMBER: PS71111-Indiana

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