Remote SCA Appeals Specialist I

Elevance Health, Inc.; Tampa (FL); Remote; USD 42,000 - 54,000; Full time

Job summary

Elevance Health, Inc. seeks an SCA Appeals Representative I to review and process non-complex grievances and appeals related to Part A and B services. The role supports customer types including members, providers, and third parties, in a remote/virtual setting with occasional in-person training sessions.

The position requires a high school diploma or GED and at least 1 year of experience in grievances, appeals, claims, or customer service. Strong medical terminology and writing skills are a plus.

Qualifications

• Requires a high school diploma or GED and at least 1 year in grievances, appeals, claims or customer service.
• This is part of the Wellpoint Federal division with residency rules.
• Familiarity with medical coding and terminology preferred.

Responsibilities

• Reviews, analyzes, and processes non complex grievances and appeals per guidelines.
• Researches and analyzes the grievance and pertinent claims and records for decisions.
• Routes information to nursing/medical staff and other departments as needed.
• Acts as liaison between grievances, appeals and medical management, legal, and operations.

Skills

Medical coding familiarity

Business writing

Medicare Part A/B knowledge

Education

High school diploma or GED

Job description

Elevance Health, Inc. seeks an SCA Appeals Representative I to review and process non-complex grievances and appeals related to Part A and B services. The role supports customer types including members, providers, and third parties, in a remote/virtual setting with occasional in-person training sessions.

The position requires a high school diploma or GED and at least 1 year of experience in grievances, appeals, claims, or customer service. Strong medical terminology and writing skills are a plus.