Senior Appeals Specialist - Health Benefits (Remote)

Elevance Health, Inc.; Wilmington (DE); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Elevance Health, Inc. seeks a Sr. SCA Appeals Representative to investigate and review customer appeals regarding service provision and benefit coverage issues.

This role supports federal programs through Wellpoint Federal, focusing on grievances and appeals and non-clinical service challenges. The ideal candidate triages inquiries, prepares case files, summarizes information for clinicians and legal counsel, and ensures timely resolution, with strong knowledge of benefits contracts and Medicare

Qualifications

• Requires high school diploma and at least 4 years in grievances/appeals or equivalent background.
• Experience with benefit contracts, pricing, and regulatory policies is preferred.
• Strong verbal and written communication skills are essential.
• Familiarity with Medicare Part A & B is preferred.

Responsibilities

• Triages clinical and non-clinical inquiries, grievances and appeals.
• Prepares case files for member grievance committees/hearings.
• Summarizes information for clinical staff, legal counsel, and decision-makers.
• Responds to oral and written complaints and ensures timely resolution.
• Documents interactions and communicates dispositions to customers.
• Gathers information, conducts research, and supports complex cases.

Skills

Grievances & Appeals Experience

Medicare Part A & B knowledge

Benefits Contracts Knowledge

Verbal Communication

Written Communication

Education

High School Diploma

Job description

Elevance Health, Inc. seeks a Sr. SCA Appeals Representative to investigate and review customer appeals regarding service provision and benefit coverage issues.

This role supports federal programs through Wellpoint Federal, focusing on grievances and appeals and non-clinical service challenges. The ideal candidate triages inquiries, prepares case files, summarizes information for clinicians and legal counsel, and ensures timely resolution, with strong knowledge of benefits contracts and Medicare