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Mgr I Grievance/Appeals-in office Tampa FL-PS26409Location: Tampa, Florida, United StatesNewRequisition #: PS26409Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater 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 benefits companies and a Fortune Top 50 Company.Manager I, Grievance/Appeals-in office Tampa FLResponsible for management oversight of receipt, investigation and processing associated with member/provider grievance and appeals.Primary duties may include, but are not limited to:
Monitors, trends and analyzes grievance and appeals data for submission to appropriate parties.
Serves as clinical resource expert and mentor to unit and other departments for complex issues and interpretation of regulatory standards.
Performs internal audits of grievance and appeals process.
Ensures appeals and grievances are resolved within regulatory timeframes.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Develops training materials
Requires:
3-5 years leadership experience in grievance & appeals, claims or customer services in the healthcare industry
or any combination of education and experience, which would provide an equivalent background.
BA/BS preferred.
Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Experience with internal/external audit activities with CMS preferred
Familiarity with Medicare G&A requirements preferred
Experience sending appeal files to Maximus Federal Services preferred
Proficiency with MS Office Suite
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.
