Job Details

ID #4517207
Estado Kentucky
Ciudad Lexington
Full-time
Salario USD TBD TBD
Fuente Anthem, Inc.
Showed 2020-08-05
Fecha 2020-08-06
Fecha tope 2020-10-05
Categoría Etcétera
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Appeals Rep II

Kentucky, Lexington 00000 Lexington USA

Vacancy caducado!

Description SHIFT: Day JobSCHEDULE: Full-timeYour 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.Title: Appeals Rep II Location: Tampa, Florida This position will be work from home at the time of hire. When the Anthem offices re-open, the position will most likely transition

to work onsite. The

Appeals II rep is responsible for reviewing, analyzing and processing

policies related to claims events to determine the extent of the company's

liability and entitlement. Primary duties may include, but are not limited

to: · Conducts investigation and review of member appeals (and grievances)

involving provision of service and benefit coverage issues.· Contacts members 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.· May make decision on administrative appeals where guidelines are well

documented and involve limited discretion.· 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 Appeals committees/hearings. Summarizes and

presents essential information for the clinical specialist or medical director

and legal counsel.· Work with internal and external partners to obtain

information for timely case resolutionQualifications · Requires a HS diploma or equivalent;2-4 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.Ability to organize work, set and manage multiple priorities in a time

sensitive manner.Basic word processing, data base management, and spreadsheet skills

required.PC proficiency.Good oral and written communication skills.Claims knowledge is helpful.Medicare experience is a plusREQNUMBER: PS37078

Vacancy caducado!

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