Remote SCA Appeals Specialist I

Elevance Health, Inc.; Miami (FL); Híbrido; USD 42.000 - 56.000; Jornada completa

Descripción de la vacante

Elevance Health, including its Wellpoint Federal division, seeks an SCA Appeals Representative I to review and process non‑complex grievances and appeals related to Part A & B services, focusing on quality of service and care. This hybrid/virtual role supports onboarding and requires some in-person training sessions.

The successful candidate brings experience in grievances/appeals, claims, or customer service, plus familiarity with medical coding and provider networks.

Formación

• High school diploma or GED and 1 year in grievances/appeals, claims, or customer service.
• Ability to review non-complex grievances per regulatory and internal policies.
• Must meet residency requirement per CMS TDL 190275.

Responsabilidades

• Reviews, analyzes, and processes non-complex grievances and appeals.
• Researches claims and medical records to support decisions.
• Routes information to nursing/medical staff for review.
• Acts as liaison between grievances/appeals and medical management or other departments.

Conocimientos

Grievances & appeals

Claims processing

Customer service

Medical coding

Educación

High school diploma or GED

Herramientas

EMR systems

Descripción del empleo

Elevance Health, including its Wellpoint Federal division, seeks an SCA Appeals Representative I to review and process non‑complex grievances and appeals related to Part A & B services, focusing on quality of service and care. This hybrid/virtual role supports onboarding and requires some in-person training sessions.

The successful candidate brings experience in grievances/appeals, claims, or customer service, plus familiarity with medical coding and provider networks.