Grievance/Appeals Analyst

As a Grievance/Appeals Analyst at Elevance Health, you will play an important role in ensuring our members' satisfaction through effective management of appeals and grievances. In this position, you will have the opportunity to leverage your analytical and problem-solving skills to investigate and resolve appeals and grievances from our members in a timely and accurate manner.To be successful in this role, you must have excellent communication and organizational skills, as well as the ability to make sound decisions in a fast-paced environment. Knowledge of medical terminology, coding, and reimbursement systems is also required. If you are a strong critical thinker and enjoy working in a collaborative team setting, we would love to hear from you!

Responsibilities:

1. Investigate and resolve appeals and grievances from Elevance Health members in a timely and accurate manner.
2. Maintain records of appeals and grievances in accordance with company policies and procedures.
3. Analyze and interpret medical terminology, coding, and reimbursement systems to support investigations.
4. Utilize problem-solving skills to assess member appeals and grievances.
5. Handle incoming appeals and grievances from members in a professional and efficient manner.
6. Provide appropriate responses to members in a timely manner.
7. Document all proceedings and resolutions in accordance with company policies and procedures.
8. Work collaboratively with other departments to ensure accurate and timely resolution of appeals and grievances.
9. Monitor compliance with regulatory requirements and company policies.
10. Maintain effective communication with members throughout the appeal and grievance process.

According to JobzMall, the average salary range for a Grievance/Appeals Analyst in St. Louis, MO, USA is between $50,000 and $70,000. The salary range may vary depending on the experience and qualifications of the candidate.

Elevance Health, Inc. is an American health insurance provider. The company's services include medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans through affiliated companies such as Anthem Blue Cross and Blue Shield, Empire BlueCross BlueShield in New York State, Anthem Blue Cross in California,Wellpoint, and Carelon.It is the largest for-profit managed health care company in the Blue Cross Blue Shield Association. As of 2022, the company had 46.8 million members within their affiliated companies' health plans. Prior to June 2022, Elevance Health was named Anthem, Inc.