Entry-Level Grievance & Appeals Specialist — Hybrid

Elevance Health (Anthem); Boght Corners (NY); Hybrid; USD 27,000 - 34,000; Full time

Job summary

Elevance Health in Latham, NY, is hiring a Grievance/Appeals Representative I for a hybrid schedule (1–2 in-office days weekly). You will review, analyze and process claims to determine liability and entitlement, interfacing with members and providers while ensuring timely resolutions.

The role emphasizes investigation, information gathering and written communication, with an entry-level path in the Enterprise Grievance & Appeals Department.

Qualifications

• HS diploma or equivalent and 1 year health insurance/customer service experience.
• Strong verbal and written communication, organizational and interpersonal skills.
• Proficiency with PC applications and standard software.

Responsibilities

• Investigate and review customer grievances and appeals related to service and benefit coverage.
• Contact customers to gather information and communicate case disposition; document interactions.
• Generate written correspondence to members, providers and regulatory agencies.
• Research policy provisions to determine liability and entitlement for providers/beneficiaries.
• Respond to appeals from various units and customers to resolve or affirm processed claims.
• Ensure resolution within regulatory or customer-required timeframes.
• Identify barriers to customer satisfaction and recommend process improvements.

Skills

Verbal communication

Written communication

Organizational skills

Interpersonal skills

PC proficiency

Education

HS diploma or equivalent

Job description

Elevance Health in Latham, NY, is hiring a Grievance/Appeals Representative I for a hybrid schedule (1–2 in-office days weekly). You will review, analyze and process claims to determine liability and entitlement, interfacing with members and providers while ensuring timely resolutions.

The role emphasizes investigation, information gathering and written communication, with an entry-level path in the Enterprise Grievance & Appeals Department.