Grievance & Appeals Analyst II - Drive Quality (Hybrid)

Elevance Health; Indianapolis (IN); Hybride; USD 26 000 - 48 000; Plein temps

Avantages offerts par ce poste

Medical benefits

401(k)

Hybrid work model

Résumé du poste

Elevance Health is seeking a Grievance & Appeals Analyst to review and process grievances and appeals across multiple plans and stakeholders. You will research, analyze claims and medical records, and document determinations in alignment with accreditation standards.

The role requires strong analytical and communication skills, with a focus on quality and customer service in a hybrid work environment.

Qualifications

• 1+ year experience in Grievance & Appeals analysis or related fields.
• Strong written and oral communication skills.
• Familiarity with accreditation standards (URAC/NCQA) is a plus.

Responsabilités

• Review and process non-complex and some complex grievances and appeals.
• Analyze claims and medical records to determine determinations.
• Prepare written communications to convey determinations and route for review as needed.
• Maintain compliance with accreditation and regulatory standards.

Connaissances

Grievances & Appeals

Customer service

Analytical skills

Communication skills

Formation

HS diploma or equivalent

Associates degree preferred

Outils

Guidelines & review tools

Description du poste

Elevance Health is seeking a Grievance & Appeals Analyst to review and process grievances and appeals across multiple plans and stakeholders. You will research, analyze claims and medical records, and document determinations in alignment with accreditation standards.

The role requires strong analytical and communication skills, with a focus on quality and customer service in a hybrid work environment.