Coordinator

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Appeals Coordinator

Job Family : UNN >

Union 061

Type : Full time

Date Posted : Mar 04, 2024

Anticipated End Date : Jun 24, 2024

Reference : JR107632

Location : MI, WIXOM

MI, WIXOM

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Description

Location : 100% Remote

Hours : Monday-Friday 11-7 : 30pm EST

The Grievance / Appeals Rep II is responsible for reviewing, analyzing and processing policies related to claims events to determine the extent of the company's liability and entitlement.

How you will make an impact :

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.

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.

Requirements :

HS diploma or equivalent and a minimum of 1 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.

Preferred Skills, Capabilities and Experience :

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.

For candidates working in person or remotely in the locations below, the hourly range for this specific position is $14.45 to $28.69. *

Locations : California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJ

I In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company.

The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting.

This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.

Even within the range, the actual compensation will vary depending on the above factors as well as market / business considerations.

No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans.

The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health.

Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates.

Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

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.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week.

Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient / member-facing roles to become vaccinated against COVID-19.

If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health 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 elevancehealthjobssupport@elevancehealth.com for assistance.

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Last updated : 2024-03-05