Remote Senior Appeals Specialist - SCA & Medicare

Elevance Health, Inc.; Tampa (FL); Híbrido; USD 60.000 - 85.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Hybrid/virtual work option

Training sessions in-person as needed

Descripción de la vacante

Elevance Health, Inc. is seeking a Sr. SCA Appeals Representative to investigate and review member appeals related to service and benefit coverage. The role supports Wellpoint Federal and requires navigating complex regulatory guidelines with a focus on timely resolutions.

The position emphasizes ongoing education in benefits, CMS regulations, and collaboration with clinical staff, legal counsel, and regulators to improve customer satisfaction and health outcomes.

Formación

• Requires high school diploma or equivalent and 4 years' experience in grievances/appeals.
• Experience with regulatory guidelines and CMS requirements is preferred.
• Strong written and verbal communication skills are essential.

Responsabilidades

• Triages inquiries, grievances and appeals from members.
• Prepares case files for grievance committees/hearings.
• Summarizes information for clinical staff, legal counsel, and regulators.
• Responds to oral and written complaints and ensures timely resolutions.
• Documents interactions and tracks inquiry/appeal information.

Conocimientos

Grievances & appeals

Communication (verbal & written)

PC proficiency

Customer service orientation

Regulatory knowledge (CMS)

Educación

High School Diploma or equivalent

Herramientas

MS Office

Descripción del empleo

Elevance Health, Inc. is seeking a Sr. SCA Appeals Representative to investigate and review member appeals related to service and benefit coverage. The role supports Wellpoint Federal and requires navigating complex regulatory guidelines with a focus on timely resolutions.

The position emphasizes ongoing education in benefits, CMS regulations, and collaboration with clinical staff, legal counsel, and regulators to improve customer satisfaction and health outcomes.