Hybrid Grievance & Appeals Associate I

Elevance Health; Latham (NY); Hybride; USD 27 000 - 34 000; Plein temps

Résumé du poste

Elevance Health in New York is seeking a Grievance/Appeals Representative I to review, analyze and process claims in accordance with policies and claims events to determine the extent of the company's liability and entitlement.

This entry-level role, in the Enterprise Grievance & Appeals Department, involves investigating complaints, communicating dispositions to members and providers, and ensuring timely resolutions while supporting a hybrid in-office/remote work model.

Qualifications

• Requires a HS diploma or equivalent and a minimum of 1 year experience in health insurance business including customer service.
• Excellent verbal and written communication.
• Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Responsabilités

• Investigates customer grievances and appeals.
• Contacts customers to gather information and communicate disposition of cases.
• Documents interactions and generates written correspondence to members, providers and regulators.
• Interprets policy provisions to determine liability and entitlement.
• Ensures resolution within required timeframes per regulatory or customer needs.

Connaissances

Verbal communication

Written communication

Organizational skills

Interpersonal skills

PC proficiency

Formation

HS diploma or equivalent

Description du poste

Elevance Health in New York is seeking a Grievance/Appeals Representative I to review, analyze and process claims in accordance with policies and claims events to determine the extent of the company's liability and entitlement.

This entry-level role, in the Enterprise Grievance & Appeals Department, involves investigating complaints, communicating dispositions to members and providers, and ensuring timely resolutions while supporting a hybrid in-office/remote work model.