Grievances & Appeals Analyst – Remote, Entry-Level

Elevance Health; Costa Mesa (CA); Hybrid; USD 30,000 - 41,000; Full time

Job summary

Elevance Health is seeking an entry level Analyst in the Enterprise Grievance & Appeals Department in California. The role focuses on reviewing non-complex grievances and appeals across multiple products, composing clear determinations, and coordinating with nursing/medical staff when needed.

The ideal candidate has a HS diploma or GED with 3 years in grievances/claims/customer service, strong writing, and knowledge of Commercial HMO processes.

Qualifications

• Strong oral, written and interpersonal communication skills.
• Experience in Commercial Grievances & Appeals.
• Demonstrated business writing proficiency and understanding of provider networks.

Responsibilities

• Reviews, analyzes and processes non-complex grievances and appeals per external accreditation and regulatory requirements.
• Researches and analyzes grievance/appeal issues using claims and medical records to determine a course of action.
• Drafts clear, written determinations and routes to appropriate medical staff when needed.
• Serves as a liaison between grievances & appeals and other internal departments.

Skills

Communication skills

Business writing

Grievances & Appeals experience

Interpersonal skills

Commercial HMO knowledge

Education

HS diploma or GED

Job description

Elevance Health is seeking an entry level Analyst in the Enterprise Grievance & Appeals Department in California. The role focuses on reviewing non-complex grievances and appeals across multiple products, composing clear determinations, and coordinating with nursing/medical staff when needed.

The ideal candidate has a HS diploma or GED with 3 years in grievances/claims/customer service, strong writing, and knowledge of Commercial HMO processes.