Remote Grievance & Appeals Analyst (Contract)

Elevance Health; Walnut Creek (CA); Hybrid; USD 31,000 - 43,000; Full time

Job summary

Elevance Health in California is seeking an entry-level analyst in the Enterprise Grievance & Appeals Department to review and process non-complex pre-service and post-service grievances and appeals across multiple products.

You will analyze records, draft clear determinations, and coordinate with medical staff as needed, while adhering to URAC and NCQA standards. Remote work is allowed with some onsite requirements in California.

Qualifications

• HS diploma or GED and a minimum of 3 years experience in grievances, appeals, claims, or customer service.
• Strong business writing proficiency and knowledge of provider networks.
• Experience in Commercial Grievances & Appeals.
• Prefer Commercial HMO knowledge.

Responsibilities

• Reviews, analyzes and processes non-complex grievances and appeals per rules and policies.
• Researches claims and medical records to determine approvals or routes for review.
• Ensures documentation meets external accreditation and regulatory standards.
• Follows department guidelines and tools for case reviews.
• Interacts with other departments as a liaison when needed.

Skills

Communication

Grievances & Appeals experience

Education

HS diploma or GED

Job description

Elevance Health in California is seeking an entry-level analyst in the Enterprise Grievance & Appeals Department to review and process non-complex pre-service and post-service grievances and appeals across multiple products.

You will analyze records, draft clear determinations, and coordinate with medical staff as needed, while adhering to URAC and NCQA standards. Remote work is allowed with some onsite requirements in California.