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Grievance & Appeals Analyst I

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Anthem, IncGlendale, CA
  • Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For, is ranked as one of the 2020 Worlds Most Admired Companies among health insurers by Fortune magazine, and a 2020 Americas Best Employers for Diversity by Forbes.
  • At Anthem, Inc., its a powerful combination, and the foundation upon which were creating greater access to care for our members, greater value for our customers, and greater health for our communities.
  • Qualifications + Requires a High school diploma or GED; 3 to 5 years experience working in grievances and appeals, claims, or customer service, familiarity with medical coding and medical terminology, demonstrated business writing proficiency, understanding of provider networks, the medical management process, claims process, the company's internal business processes, and internal local technology; or any combination of education and/or experience which would provide an equivalent background.
  • + The file review components of the URAC and NCQA accreditations are must pass items to achieve the accreditation.
  • + Utilizes guidelines and review tools to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route to nursing and/or medical staff for review.
  • + The grievance and appeal work is subject to applicable accreditation and regulatory standards and requirements.
  • + Analyzes and renders determinations on assigned non-complex grievance and appeal issues and completion of the respective written communication documents to convey the determination.
  • 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.

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