Senior SCA Appeals Representative - Remote

Elevance Health, Inc.; United States; Remote; USD 70,000 - 95,000; Full time

Job summary

Elevance Health is seeking a Sr. SCA Appeals Representative to investigate and resolve member appeals and service/benefit coverage issues. This remote role supports virtual work with occasional in-person trainings and strict commuting distance requirements from offices.

The Senior role emphasizes reviewing complex cases, coordinating with clinical and legal teams, and ensuring timely resolutions while maintaining regulatory compliance. Strong communication and Medicare knowledge are preferred.

Qualifications

• High school diploma or equivalent; 4+ years in grievances/appeals.
• Residency: must have lived in the United States for at least 3 of the past 5 years.
• Experience with Medicare Part A and B knowledge preferred.

Responsibilities

• Triages clinical and non-clinical inquiries, grievances and appeals.
• Prepares case files for member grievance committees/hearings.
• Summarizes information for clinical specialist or medical director and legal counsel.
• Responds to oral and written complaints.
• Ensures timely resolution within regulatory and customer needs.

Skills

Grievances & appeals

Case file preparation

Medicare benefits knowledge

Communication skills

Regulatory compliance

Education

High school diploma

Job description

Elevance Health is seeking a Sr. SCA Appeals Representative to investigate and resolve member appeals and service/benefit coverage issues. This remote role supports virtual work with occasional in-person trainings and strict commuting distance requirements from offices.

The Senior role emphasizes reviewing complex cases, coordinating with clinical and legal teams, and ensuring timely resolutions while maintaining regulatory compliance. Strong communication and Medicare knowledge are preferred.