SCA Appeals Representative I

Elevance Health (Anthem); Indianapolis (IN); Hybrid; USD 42,000 - 56,000; Full time

Benefits offered by this job

Medical, dental, vision benefits

401(k) + match

Paid time off & holidays

Incentive bonus programs

Job summary

Elevance Health in the United States is seeking an SCA Appeals Representative I to review and process non-complex grievances and appeals for Part A and B, involving members, providers, and regulatory bodies. You will analyze claims and medical records, coordinate with nursing/medical staff, and ensure adherence to internal policies and external requirements.

The role emphasizes accuracy, customer service, and cross-functional collaboration within the Wellpoint Federal division, with

Qualifications

• Familiarity with medical coding and medical terminology strongly preferred.
• Business writing proficiency and understanding of provider networks and claims processes.
• Part A and B Medicare knowledge is preferred.

Responsibilities

• Reviews, analyzes, and processes non-complex grievances and appeals per guidelines.
• Researches and analyzes issues using claims data and medical records.
• Routes information to nursing/medical staff for review and follows internal processes.
• Acts as liaison between grievances/appeals and medical management and other departments.

Skills

Medicare knowledge

Medical terminology

Business writing

Education

High school diploma or GED

Job description

Anticipated End Date: 2026-11-28

Position Title: SCA Appeals Representative I

Job Description

Virtual : This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.

Wellpoint Federal, a subsidiary of Elevance Health, brings deep industry expertise and healthcare service capabilities to support federal programs. The organization delivers solutions across claims administration, data, and care delivery to help address complex challenges and improve health outcomes for federal populations.

The SCA Appeals Representative I is responsible for reviewing, analyzing, and processing non-complex pre and post service grievances and appeals requests from customer types (i.e., member, provider, regulatory, and third party) and multiple products (Part A & B) which are related to clinical and non-clinical services, quality of service, and quality of care issues to include executive and regulatory grievances.

How you will make an impact

• Reviews, analyzes, and processes non-complex grievances and appeals in accordance with external accreditation and regulatory requirements as well as internal policies and claims events requiring written responses.
• Utilizes guidelines and review tools to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize.
• Routes summaries and information to nursing and/or medical staff for review. Strictly follows department guidelines and tools to conduct reviews.
• Serves as a liaison between grievances & appeals and /or medical management, legal, and/or service operations and other internal departments.

Minimum Requirements

• Requires a High school diploma or GED and a minimum of 1 year experience working in grievances and appeals, claims, or customer service; or any combination of education and/or experience which would provide an equivalent background.
• This position is part of our Wellpoint Federal division which, per CMS TDL 190275, requires foreign national applicants to meet the residency requirement of living in the United States for at least three of the past five years.

Preferred Skills, Capabilities and Experiences

• Familiarity with medical coding and medical terminology strongly preferred.
• Business writing proficiency and an understanding of provider networks, the medical management process, claims process, internal business processes, and internal local technology strongly preferred.
• Part A and B Medicare knowledge is preferred

Job Level

Non-Management Non-Exempt

Workshift

1st Shift (United States of America)

Job Family

SCA > SCA Wage Determination

Other Important Information

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

Benefits and Total Rewards

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Workforce Strategy

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.