Senior SCA Appeals Specialist - Remote & Impactful

Elevance Health (Anthem)

Indianapolis (IN)

Remote

USD 60,000 - 76,000

Full time

3 days ago

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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.