SCA Appeals Representative Sr.

Elevance Health (Anthem); Indianapolis (IN); Remote; USD 60,000 - 76,000; Full time

Job summary

Elevance Health is seeking a Sr. SCA Appeals Representative to investigate and resolve member grievances and billing/benefits issues. The role supports Wellpoint Federal, a subsidiary within Elevance Health, and offers virtual full-time work with required onboarding sessions.

A high school diploma and 4+ years in grievances/appeals are required, with CMS residency rules applying. Responsibilities include triage, case preparation for hearings, and clear communication with members, providers, and

Qualifications

• Requires high school diploma or equivalent and 4+ years related grievances/appeals experience.
• CMS residency requirement: U.S. residency for 3 of the past 5 years.
• Experience with benefits contracts, pricing, policies and regulations.

Responsibilities

• Triages clinical and non-clinical inquiries, grievances and appeals.
• Prepares case files for member grievance committees/hearings.
• Summarizes information for clinical specialist, medical director and legal counsel.
• Responds to oral and written complaints and documents interactions.
• Ensures timely resolution within regulatory and customer timeframes.
• Contacts customers to gather information and communicate dispositions.

Skills

Grievances & appeals experience

Communication skills

Organizational skills

Interpersonal skills

PC proficiency

Benefits contracts understanding

Regulatory knowledge

Appeals knowledge

Medicare Part A & B knowledge

Education

High school diploma or equivalent

Job description

Anticipated End Date

2026-11-28

Position Title

SCA Appeals Representative Sr.

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.

About the Company

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.

Job Overview

The SCA Appeals Representative Sr. is responsible for investigating and reviewing customer appeals regarding provision of service and benefit coverage issues.

How you will make an impact

• Triages clinical and non-clinical inquiries as well as grievances and appeals.
• Prepares case files for member grievance committees/hearings.
• Summarizes and presents essential information for the clinical specialist or medical director and legal counsel.
• Responds to oral and written complaints.
• Ensures appropriate resolution to inquiries, grievances and appeals within specified timeframes established by either regulatory/accreditation agencies or customer needs.
• Contacts customers to gather information and communicate disposition of case; documents interactions.
• Generates written correspondence to customers such as members, providers and regulatory agencies. Identifies barriers to customer satisfaction and recommends actions to address operational challenges.
• Pursues ongoing education/training on benefits/services to ensure accurate resolution of grievances and appeals, and overall industry knowledge and development (i.e. HIAA, LOMA, etc.). Documents and logs inquiry/appeal/grievance information in tracking system.
• Under minimal supervision, resolves inquiries as well as grievances and appeals requests from all customer and product types related to non-clinical services and quality of service issues.
• Handles more complex customer issues requiring adaptation of responses or extensive research.
• Makes administrative exceptions within prescribed guidelines.
• Investigates, summarizes, and makes recommendations for non-clinical cases.
• Actively seeks, evaluates and understands information needed to make effective decisions.
• Assists other grievance and appeals staff on file decisions.
• Provides direction and guidance to other team members.
• Provides leadership and fosters a supportive environment.
• Performs other related duties as required.

Minimum Requirements

• Requires high school diploma or equivalent and a minimum 4 years related experience working in grievances and appeals; 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

• Understanding of the application of benefits contracts, pricing, policies and legislative regulations, verbal and written communication skills, organizational skills, interpersonal skills, PC proficiency strongly preferred.
• Appeals knowledge is heavy preferred.
• Knowledge of Part A and B Medicare is preferred.

Job Level

Non-Management Non-Exempt

Workshift

1st Shift (United States of America)

Job Family

SCA > SCA Wage Determination

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 associa