Senior SCA Appeals Lead - Remote with Onsite Training

Elevance Health, Inc.; Miami (FL); A distancia; USD 75.000 - 95.000; Jornada completa

Descripción de la vacante

Elevance Health, Inc. is seeking a Sr. SCA Appeals Representative to work remotely with the potential for in-person training sessions.

This role operates within Wellpoint Federal, Elevance Health's federal division, and focuses on investigations of service and benefit coverage grievances and appeals. The incumbent will triage inquiries, prepare case files for committees and hearings, summarize information for the clinical director and legal counsel, and communicate dispositions to customers

Formación

• Requires high school diploma or equivalent and a minimum 4 years related experience in grievances and appeals.
• Must meet residency requirement of living in the United States for at least three of the past five years.

Responsabilidades

• Triages clinical and non-clinical inquiries, 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 timely resolution to inquiries, grievances and appeals within required timeframes and documents interactions.
• Generates written correspondence to members, providers and regulatory agencies.

Conocimientos

Benefits contracts knowledge

Appeals knowledge

Medicare Part A/B knowledge

Educación

High school diploma or equivalent

Descripción del empleo

Elevance Health, Inc. is seeking a Sr. SCA Appeals Representative to work remotely with the potential for in-person training sessions.

This role operates within Wellpoint Federal, Elevance Health's federal division, and focuses on investigations of service and benefit coverage grievances and appeals. The incumbent will triage inquiries, prepare case files for committees and hearings, summarize information for the clinical director and legal counsel, and communicate dispositions to customers