Remote SCA Appeals Specialist – Grievances & Claims

Elevance Health, Inc.; Wilmington (DE); Hybrid; USD 42,000 - 64,000; Full time

Job summary

Elevance Health, Inc. is seeking a SCA Appeals Representative I to review and process non‑complex grievances and appeals across multiple products. The role supports virtual full‑time work with required in‑person training and occasional alternate locations within commuting distance.

The position is part of Wellpoint Federal and requires adherence to CMS residency requirements. Prior experience in grievances or customer service is preferred and familiarity with medical coding is a plus.

Qualifications

• Requires a High school diploma or GED and a minimum of 1 year experience working in grievances and appeals, claims, or customer service.
• This position is part of Wellpoint Federal division which requires residency in the United States for at least three of the past five years.

Responsibilities

• Reviews, analyzes, and processes non‑complex grievances and appeals per external accreditation and regulatory requirements and internal policies.
• Uses guidelines and review tools to conduct research and decide on approve or summarize actions.
• Routes summaries to nursing/medical staff for review and follows department guidelines.
• Acts as a liaison between grievances/appeals and medical management, legal, and service operations.

Skills

HS diploma or GED

1+ year grievances & appeals

CMS residency compliance

Job description

Elevance Health, Inc. is seeking a SCA Appeals Representative I to review and process non‑complex grievances and appeals across multiple products. The role supports virtual full‑time work with required in‑person training and occasional alternate locations within commuting distance.

The position is part of Wellpoint Federal and requires adherence to CMS residency requirements. Prior experience in grievances or customer service is preferred and familiarity with medical coding is a plus.