Anthem, Inc. Grievance & Appeals Coordinator in Austin, Texas
SHIFT: Day Job
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.
Responsible for investigating and reviewing customer grievances and appeals regarding provision of service and benefit coverage issues. Triages clinical and non-clinical inquiries, grievances and appeals, prepares case files for member grievance committees/hearings.
Primary duties may include, but are not limited to:
Summarizes and presents essential information for the clinical specialist or medical/dental director and legal counsel.
Responds to oral and written complaints sent to the Office of the Chairman, President or Vice President complaints.
Ensures appropriate resolution to inquiries, grievances and appeals within specified timeframes established by either regulatory/accreditation agencies or customer needs.
Contacts members to gather information and communicate disposition of case; documents interactions.
Generates written correspondence to members, providers and regulatory agencies.
Identifies barriers to customer satisfaction and recommends actions to address operational challenges.
Pursues ongoing education/training on benefits/services to ensure accurate resolution of grievances and appeals, and overall industry knowledge and development (i.e. HIAA, LOMA, etc.).
Operates a PC/image station to obtain and extract information; documents information, activities and changes in the database.
Requires a HS Diploma or equivalent and 4 years progressively complex experience working in grievances and appeals; or any combination of education and experience, which would provide an equivalent background.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2019 DiversityInc magazine Top 50 Company for Diversity.
To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.
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