Grievance/Appeals Representative (Latham, NY)

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

Anticipated End Date: 2026-10-23

Position Title: Grievance/Appeals Representative (Latham, NY)

Job Description

Grievance/Appeals Representative I

Shift: Monday - Friday

Location: Hybrid 1: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.

The Grievance/Appeals Representative I is an entry level position in the Enterprise Grievance & Appeals Department that will be responsible for reviewing, analyzing and processing claims in accordance with policies and claims events to determine the extent of the company's liability and entitlement.

How you will make an impact:

• Conducts investigation and review of customer grievances and appeals involving provision of service and benefit coverage issues.
• Contacts customers to gather information and communicate disposition of case; documents interactions.
• Generates written correspondence to customers such as members, providers and regulatory agencies.
• Performs research to respond to inquiries and interprets policy provisions to determine the extent of company's liability and/or provider's/beneficiaries entitlement.
• Responds to appeals from CS Units, Provider Inquiry Units, members, providers and/or others for resolution or affirmation of previously processed claims.
• Ensures appropriate resolution to inquiries, grievances and appeals within specified timeframes established by either regulatory/accreditation agencies or customer needs.
• Identifies barriers to customer satisfaction and recommends actions to address operational challenges.

Minimum Requirements

Requires a HS diploma or equivalent and a minimum of 1 year experience in health insurance business including customer service experience; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences

Good verbal and written communication, organizational, interpersonal skills and PC proficiency strongly 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

For candidates working in person or virtually in the below locations, the salary* range for this specific position is $19.54 to $24.43

Location: New York

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is 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.

Job Level

Non-Management Non-Exempt

Workshift:

Job Family

CLM > Claims Support

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking f