Remote SCA Appeals Associate – Grievances & Appeals

Elevance Health (Anthem); Indianapolis (IN); Hybrid; USD 42,000 - 56,000; Full time

Benefits offered by this job

Medical, dental, vision benefits

401(k) + match

Paid time off & holidays

Incentive bonus programs

Job summary

Elevance Health in the United States is seeking an SCA Appeals Representative I to review and process non-complex grievances and appeals for Part A and B, involving members, providers, and regulatory bodies. You will analyze claims and medical records, coordinate with nursing/medical staff, and ensure adherence to internal policies and external requirements.

The role emphasizes accuracy, customer service, and cross-functional collaboration within the Wellpoint Federal division, with

Qualifications

• Familiarity with medical coding and medical terminology strongly preferred.
• Business writing proficiency and understanding of provider networks and claims processes.
• Part A and B Medicare knowledge is preferred.

Responsibilities

• Reviews, analyzes, and processes non-complex grievances and appeals per guidelines.
• Researches and analyzes issues using claims data and medical records.
• Routes information to nursing/medical staff for review and follows internal processes.
• Acts as liaison between grievances/appeals and medical management and other departments.

Skills

Medicare knowledge

Medical terminology

Business writing

Education

High school diploma or GED

Job description

Elevance Health in the United States is seeking an SCA Appeals Representative I to review and process non-complex grievances and appeals for Part A and B, involving members, providers, and regulatory bodies. You will analyze claims and medical records, coordinate with nursing/medical staff, and ensure adherence to internal policies and external requirements.

The role emphasizes accuracy, customer service, and cross-functional collaboration within the Wellpoint Federal division, with