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Manager of Grievance / Appeals I / II

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AnthemEast Syracuse, NY
  • Description SHIFT: Day Job SCHEDULE: Full-time Your Talent.
  • 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.
  • 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 Responsible for management oversight of receipt, investigation and processing associated with member/provider grievance and appeals.
  • 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.
  • May perform 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.
  • Manager II Grievance/Appeals Responsible for management oversight of grievances and appeals departmental units to investigate, resolve, and respond to client/provider grievances/appeals and ensure compliance with regulatory requirements.
  • Maintains and coordinates staff activities to achieve departmental and corporate goals to improve service to customers/providers and assures regulatory compliance.
  • Analyzes and develops strategies by achieving performance thresholds within budgetary guidelines.
  • Addresses both internal/external customer/provider needs and concerns related to team activities.
  • Ensures programs support overall QI program and meet regulatory compliance/accreditation and the company standards.
  • Qualifications Manager I Grievance/Appeals 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.
  • For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
  • Manager II Grievance/Appeals Requires 5 + years grievance & appeals experience and 3-5 years of management experience in the healthcare industry; or any combination of education and experience, which would provide an equivalent background.
  • Anthem, Inc. is ranked as one of Americas 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.
  • An Equal Opportunity Employer/Disability/Veteran.

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