Remote Grievances & Appeals Analyst (Entry-Level)

Elevance Health; Los Angeles (CA); Hybrid; USD 29,000 - 41,000; Full time

Benefits offered by this job

Comprehensive benefits

Job summary

Elevance Health in California seeks an entry-level Grievances & Appeals Analyst to support non-complex grievances and appeals, across multiple products, with emphasis on clear written communication and regulatory awareness.

You will research claims and medical records, render determinations, and coordinate with nursing, medical staff, and service operations while following URAC and NCQA guidelines. The hybrid role requires onsite presence as needed.

Qualifications

• Requires a HS diploma or GED and a minimum of 3 years experience working in grievances and appeals, claims, or customer service; or any combination of education and experience which would provide an equivalent background.
• Demonstrated business writing proficiency, understanding of provider networks, the medical management process, claims process, the company's internal business processes, and internal local technology is strongly preferred.
• Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
• Requires to already have experience in Commercial Grievances & Appeals.
• Strong preference for Commercial HMO business knowledge.

Responsibilities

• Reviews non-complex grievances and appeals per policy and regulatory requirements.
• Researches and analyzes grievance and appeal issues and related claims/records.
• Renders determinations and prepares written communications.
• Coordinates with nursing/medical staff and service operations as needed.
• Acts as liaison between grievances & appeals and other departments.
• Adheres to URAC and NCQA pass items during reviews.

Education

HS diploma or GED

Job description

Elevance Health in California seeks an entry-level Grievances & Appeals Analyst to support non-complex grievances and appeals, across multiple products, with emphasis on clear written communication and regulatory awareness.

You will research claims and medical records, render determinations, and coordinate with nursing, medical staff, and service operations while following URAC and NCQA guidelines. The hybrid role requires onsite presence as needed.