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Check with seller SCA Appeals Rep I Portland

Published date: April 3, 2022
  • Location: Portland, Maine, United States

Description

SHIFT: Day Job

SCHEDULE: Full-time

Be part of an extraordinary team
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

SCA Appeals Rep I

Location: targeting Harrisburg-PA, Syracuse-NY, Denison-TX, Indianapolis-IN, and South Portland-ME **open to considering a remote arrangement but must be within a commutable distance to one of the mentioned NGS or Anthem office locations**

Training: 8-week mandatory training (attendance required)
Hours/shift: Monday-Friday, standard work hours (8 1/2 hour shift)
**Start date: Monday, May 23rd 2022**

Pay: pay for this role is determined by the Government, may vary based on location, and is non-negotiable

This is an entry level position in the NGS Appeals Department that reviews, analyzes, and processes non-complex pre service and post service grievances and appeals requests from customer types (i.e. member, provider, regulatory and third party) and multiple products (Part A & B) 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:

Reviews, analyzes, and processes non-complex grievances and appeals in accordance with external accreditation and regulatory requirements, internal policies, and claims events requiring adaptation of written response in clear, understandable language.
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.
The grievance and appeal work is subject to applicable accreditation and regulatory standards and requirements. As such, the analyst will strictly follow department guidelines and tools to conduct their reviews.
Analyzes and renders determinations on assigned non-complex grievance and appeal issues and completion of the respective written communication documents to convey the determination.
Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information.
The analyst may serve as a liaison between grievances & appeals and /or medical management, legal, and/or service operations, and other internal departments.

Qualifications

This position supports Anthem's federal contracting business, which is subject to the Covid-19 vaccination requirements set forth in Executive Order 14042 and its implementing guidance. Individuals performing work in this position must be able to prove they are fully vaccinated by providing the required documentation. If you have a medical or sincerely held religious reason for not being vaccinated, consistent with applicable law, Anthem will consider requests for reasonable accommodation on this basis. Should you have any questions regarding the requirement after applying, email TalentAcquisition_VaccinationSupport@anthem.com.

Minimum requirements:
Requires a High school diploma or GED; up to 2 years experience working in grievances and appeals, claims, customer service or any combination of education and/or experience which would provide an equivalent background.

Preferred qualifications:
Familiarity with medical coding and medical terminology, demonstrated business writing proficiency, understanding of provider networks, the medical management process, claims process, the company's internal business processes, and internal local technology.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.

Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

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