Hybrid Grievance & Appeals Associate

The Elevance Health Companies, Inc.; Town of Colonie (NY); Hybrid; USD 27,000 - 34,000; Full time

Job summary

Elevance Health is seeking a Grievance/Appeals Representative I in Latham, NY, with a hybrid in-office schedule of 1–2 days per week. The role involves reviewing grievances and appeals, communicating dispositions to members and providers, and ensuring timely resolutions in alignment with policy provisions.

This is an entry-level position in the Enterprise Grievance & Appeals Department. Expect collaboration across CS units and adherence to regulatory timeframes while delivering quality service

Qualifications

• HS diploma or equivalent with at least 1 year of health insurance customer service experience.
• Strong verbal and written communication skills are required.
• Familiarity with URAC competencies and claims processes is a plus.

Responsibilities

• Review, analyze and process grievances and appeals in accordance with company policy.
• Investigate customer grievances, contact customers and document interactions.
• Generate written communications to members, providers and regulators.
• Interpret policy provisions to determine liability and entitlement.
• Resolve inquiries and appeals within required timeframes.
• Identify barriers to satisfaction and recommend improvements.

Skills

Verbal communication

Written communication

Organizational skills

Interpersonal skills

PC proficiency

Problem-solving

Facilitation

Analytical skills

Education

HS diploma or equivalent

Job description

Elevance Health is seeking a Grievance/Appeals Representative I in Latham, NY, with a hybrid in-office schedule of 1–2 days per week. The role involves reviewing grievances and appeals, communicating dispositions to members and providers, and ensuring timely resolutions in alignment with policy provisions.

This is an entry-level position in the Enterprise Grievance & Appeals Department. Expect collaboration across CS units and adherence to regulatory timeframes while delivering quality service