Description
SHIFT: Day Job
SCHEDULE: Full-time
Grievance & Appeals Risk Analyst I or II
Executive Concierge Risk Analyst I or II
United States
Be a 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 a part of a larger purpose and evolving, high-performance culture that empowers you to make an impact?
Build the Possibilities. Make an extraordinary impact.
Your Talent. Our Vision. At Anthem, Inc., it's powerful combination, and the foundation upon which we're creating greater access to care for our members., great value for our customers, and great 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 care companies and a Fortune Top 50 Company.
The Grievance & Appeals Risk Analyst I is responsible for responding to inquiries received from regulatory agencies for one or more states or functions and/or for responding to inquiries/complaints received by executive leadership. Responsible for providing support to legal, management and executive level associates through a variety of assignments and projects which utilize knowledge specific to the company.
Primary duties may include, but are not limited to:
Analyzes and evaluates inquiries, complaints, reports, and/or filings. Prepares and organizes case research, notes, and documents.
Conducts research and analysis and recommends appropriate course of action and next steps for management review.
Performs fact checking, gathers documents, researches and responds to inquiries and records requests and assists with investigative and discovery activities and processes.
Corresponds with attorneys both internal and external in grievances and appeals regulatory cases.
The Grievance & Appeals Risk Analyst II is responsible for providing support services for multiple states, enterprise-wide functions and/or complex issues through complex assignments and projects, which utilize recognized areas of specialization and knowledge specific to the company.
Primary duties may include but are not limited to:
Prepares, analyzes and evaluates written correspondence such as complaints, grievances, document demands, alleged ERISA violations and researches to resolve problems and close outstanding issues at the state or enterprise level.
Conducts research and analysis, recommends appropriate course of action and next steps.
Performs fact checking, gathers documents, researches and responds to records requests, and various inquiries from internal and external sources, coordinates investigative and discovery activities specific to Grievance and Appeal functions.
Assists with compliance issues as needed.
Attends and represents Grievances & Appeals at appropriate legal proceedings and arbitration hearings under supervision of counsel.
Participates on projects and may participate in negotiations and strategizing with business and staff.
Enters information as required into appropriate databases or other document management systems.
May serve as a resource to other support staff.
Qualifications
Grievance & Appeals Risk Analyst I Minimum Requirements:
Requires a HS diploma and a minimum of 2 years of Grievance & Appeals or related experience; or any combination of education and experience which would provide an equivalent background.
Facilitation skills required.
Grievance & Appeals Risk Analyst I Preferred Requirements:
BA/BS in a related field preferred.
Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills preferred.
Proficient in Microsoft Office.
Customer Service experience preferred
Grievance & Appeals Risk Analyst II Minimum Requirements:
Requires a HS diploma and a minimum of 5 years of Grievance & Appeals or related experience; or any combination of education and experience which would provide an equivalent background.
Facilitation skills required.
Grievance & Appeals Risk Analyst II Preferred Requirements:
BA/BS in a related field a plus.
Claims adjustment/processing experience preferred.
Proficient in Microsoft Office.
Customer Service experience preferred.
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.
REQNUMBER: PS71129-US
