Remote Medicare Grievances & Appeals Specialist

Elevance Health, Inc.; Atlanta (GA); Remote; USD 42,000 - 62,000; Full time

Job summary

Elevance Health, a Fortune 25 health company, seeks an SCA Appeals Representative I to review, analyze, and process non‑complex grievances and appeals for multiple products. The role emphasizes accuracy, regulatory alignment, and collaborative analysis with clinical teams.

The position supports flexible virtual work with required in‑person training, and requires a high school diploma and at least one year of related experience, with potential relocation considerations for office proximity.

Qualifications

• Requires a High school diploma or GED and a minimum of 1 year experience working in grievances and appeals, claims, or customer service; or any combination of education and/or experience which would provide an equivalent background.
• This position is part of Wellpoint Federal division which, per CMS TDL 190275, requires foreign national applicants to meet the residency requirement of living in the United States for at least three of the past five years.

Responsibilities

• Reviews, analyzes, and processes non‑complex grievances and appeals in accordance with external accreditation and regulatory requirements as well as internal policies and claims events requiring written responses.
• Utilizes guidelines and review tools to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize.
• Routes summaries and information to nursing and/or medical staff for review. Strictly follows department guidelines and tools to conduct reviews.
• Serves as a liaison between grievances & appeals and /or medical management, legal, and/or service operations and other internal departments.

Skills

Medical coding

Medical terminology

Business writing

Medicare knowledge

Customer service

Education

High school diploma or GED

Job description

Elevance Health, a Fortune 25 health company, seeks an SCA Appeals Representative I to review, analyze, and process non‑complex grievances and appeals for multiple products. The role emphasizes accuracy, regulatory alignment, and collaborative analysis with clinical teams.

The position supports flexible virtual work with required in‑person training, and requires a high school diploma and at least one year of related experience, with potential relocation considerations for office proximity.