Remote SCA Appeals Specialist I

Elevance Health, Inc.; United States; Remote; USD 42,000 - 64,000; Full time

Job summary

Elevance Health is hiring a SCA Appeals Representative I for a virtual role with occasional in-person training. The person reviews and processes non-complex grievances and appeals across Part A & B and related services, liaising with nursing, medical management, and internal departments.

Minimum requirements include a high school diploma or GED and at least 1 year in grievances, appeals, claims, or customer service.

Qualifications

• Requires a high school diploma or GED.
• Familiarity with medical coding and medical terminology preferred.
• Business writing proficiency and understanding of provider networks and medical management processes are preferred.

Responsibilities

• Review, analyze, and process non-complex grievances and appeals in line with external accreditation and regulatory requirements and internal policies.
• Conduct research on grievance and appeal issues using guidelines and review tools; determine disposition from medical records and claims.
• Route summaries to nursing/medical staff for review and coordinate with medical management, legal, and service operations as needed.
• Serve as a liaison between grievances/appeals and internal departments.

Skills

Medical coding familiarity

Medical terminology knowledge

Business writing proficiency

Education

High school diploma or GED

Job description

Elevance Health is hiring a SCA Appeals Representative I for a virtual role with occasional in-person training. The person reviews and processes non-complex grievances and appeals across Part A & B and related services, liaising with nursing, medical management, and internal departments.

Minimum requirements include a high school diploma or GED and at least 1 year in grievances, appeals, claims, or customer service.