Anthem Grievance/Appeals Analyst Lead - Wallingford, CT, OR Mason, OH (PS2703) in Pleasanton, California

/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.

The Grievance/Appeals Analyst Lead will be responsible for leading and coaching a team of Grievance & Appeals Analysts in the Enterprise Grievance & Appeals Department responsible to review, analyze and process pre service and post service grievances and appeals requests related to clinical and non clinical services, quality of service and quality of care issues to include executive and regulatory grievances.

Primary duties may include, but are not limited to:

  • Monitors work flow and makes assignments to ensure the correct team resource is utilized to achieve accreditation and regulatory compliance metrics in a quality manner.

  • May also be responsible to provide review and analysis of complex pre service and post service grievances and appeals requests from customer and multiple products related to clinical and non clinical services

  • Coaches, trains, and audits to ensure the team correctly utilizes guidelines and review tools to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route to nursing and/or medical staff for review.

  • Requires a HS diploma or equivalent; Associate's or BA/BS degree preferred.

  • 3 years of Grievance & Appeals analyst experience;

  • Or any combination of education and experience, which would provide an equivalent background.

  • Must live in or near the Mason, OH, area OR the Wallingford, CT, area

  • 1 year(s) of lead experience in a team setting is strongly preferred

  • Strong command of computer programs such as MS Outlook, MS Excel, MS Word

  • Experience with Pega Database and IRE is preferred

    • Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at 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 Analyst Lead - Wallingford, CT, OR Mason, OH (PS2703)

Location: california-Pleasanton

Other Locations: CT-Wallingford, OH-Mason

Requisition ID: PS2703