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Grievance/Appeals Rep I - Mason, OH (PS2734) - Gainesville, FL #4695120


Company: Anthem

Date: 03/19/2018

Category: Insurance

City: Gainesville, FL

/ Your Talent. Our Vision. / At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care .


This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.


Grievance/Appeals Representative I:


Responsible for reviewing, analyzing and processing claims in accordance with policies and claims events to determine the extent of the company's liability and entitlement.


Primary duties may include, but are not limited to:


  • Conducts investigation and review of customer grievances and appeals involving provision of service and benefit coverage issues.


  • Generates written correspondence to customers such as members, providers and regulatory agencies.


  • Performs research to respond to inquiries and interprets policy provisions to determine the extent of company's liability and/or provider's/beneficiaries entitlement.


  • Responds to appeals from CS Units, Provider Inquiry Units, members, providers and/or others for resolution or affirmation of previously processed claims.


  • Ensures appropriate resolution to inquiries, grievances and appeals within specified timeframes established by either regulatory/accreditation agencies or customer needs.


  • Identifies barriers to customer satisfaction and recommends actions to address operational challenges.


  • Requires a HS diploma or equivalent; 2 years experience in health insurance business including customer service experience; or any combination of education and experience, which would provide an equivalent background


  • Computer skills in MS Outlook, Excel, and Word, with the ability to work on several software programs simultaneously


  • Experience in an office environment is required


  • Experience in the health insurance industry is preferred


  • Good verbal and written communication, organizational and interpersonal skills


  • Must be able to work from 11am to 7:30pm

/ Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2015 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran. /


Job Claims


Equal Employment Opportunity Statement
Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.


Title: Grievance/Appeals Rep I - Mason, OH (PS2734)


Location: florida-Gainesville


Other Locations: OH-Mason


Requisition ID: PS2734




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