Senior SCA Appeals Specialist — Remote

Elevance Health, Inc.; Atlanta (GA); Remote; USD 70,000 - 100,000; Full time

Job summary

Elevance Health is seeking a Sr. SCA Appeals Representative to review and investigate member appeals related to service and benefit coverage. You will triage inquiries, prepare case files, and present essential information to clinical staff and legal counsel for timely resolutions.

Remote-friendly role with in-person training sessions as needed; requires 4+ years in grievances/appeals and US residency per CMS guidelines.

Qualifications

• 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 as per CMS TDL 190275.

Responsibilities

• 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 timely resolution to inquiries, grievances and appeals within required timeframes.

Skills

Appeals knowledge

Verbal and written communication

Organizational skills

Medicare Part A & B knowledge

Education

High school diploma or equivalent

Job description

Elevance Health is seeking a Sr. SCA Appeals Representative to review and investigate member appeals related to service and benefit coverage. You will triage inquiries, prepare case files, and present essential information to clinical staff and legal counsel for timely resolutions.

Remote-friendly role with in-person training sessions as needed; requires 4+ years in grievances/appeals and US residency per CMS guidelines.