Anthem Remote Jobs Work from Home Apply Now 2022 Limited Vacancy

Responsibilities

• 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.

Qualifications

• 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.

Preferred Qualifications/Skills/Experience:

• Behavioral health
• Managed care
• MS Office