25 Feb
Grievance/Appeals Rep I | Cerritos, CA | Job ID: PS32912
Ohio, Canton 00000 Canton USA

Vacancy expired!

Grievance/Appeals Rep I | Cerritos, CA | Job ID: PS32912Location: United StatesNewRequisition #: PS32912Your Talent. Our Vision. At CareMore ,

a proud member of the Anthem, Inc. family of companies specializing in

providing senior Americans a complete and pro-active health care experience,it’s a

powerful combination. It’s 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. Responsible for reviewing, analyzing and processing claims in accordance with policies and 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 customer grievances and appeals involving provision of service and benefit coverage issues.

Contacts customers to gather information and communicate disposition of case; documents interactions.

Generates written correspondence to customers such as members, providers and regulatory agencies.

Performs research to respond to inquiries and interprets policy provisions to determine the extent of company's liability and/or provider's/beneficiaries entitlement.

Responds to appeals from CS Units, Provider Inquiry Units, members, providers and/or others for resolution or affirmation of previously processed claims.

Ensures appropriate resolution to inquiries, grievances and appeals within specified timeframes established by either regulatory/accreditation agencies or customer needs. Identifies barriers to customer satisfaction and recommends actions to address operational challenges.

Requires a HS diploma or equivalent

1+ years experience in health insurance business including customer service experience; or any combination of education and experience, which would provide an equivalent background.

Good verbal and written communication, organizational and interpersonal skills. PC proficiency.

AnEqualOpportunityEmployer/Disability/Veteran

Vacancy expired!


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