Job Responsibilities : Grievance/Appeals Representative II – Behavioral Health
Salary : $17 per hour
Company : Anthem
Location : Remote US
- Conducts investigation and review of customer grievances and appeals involving provision of service and benefit coverage issues.
- Contacts customers to gather information and communicate disposition of case; documents interactions.
- Generates written correspondence to customers such as members providers and regulatory agencies.
- Researches administrative or non-clinical aspects of the appeal e.g. eligibility benefit levels overall adherence to policies and practices.
- May make decision on administrative appeals where guidelines are well documented and involve limited discretion.
- Prepares files for internal or external review by analysts medical staff or outside consultant.
- Triages clinical and non-clinical inquiries grievances and appeals prepares case files for member grievance committees/hearings.
- Summarizes and presents essential information for the clinical specialist or medical director and legal counsel.
- Requires a HS diploma or equivalent
- Minimum of 2 years experience in customer service preferably in a managed care environment medical office or health insurance; or any combination of education and experience which would provide an equivalent background.
- Ability to organize work set and manage multiple priorities in a time sensitive manner is strongly preferred.
- Good oral and written communication skills basic word processing data base management spreadsheet skills PC proficiency and claims knowledge strongly preferred.
- Behavioral health
- Managed care
- MS Office
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