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!