Manager II, Grievance/Appeals

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.This is an office based position and will be located in one of our Anthem office locations.Due to the current COVID-19 (coronavirus) pandemic, this position will require you to work remotely from your home with the expectation to return to a regular, in-office work environment when appropriate. The Manager II, Grievance and Appeals role is responsible for managing RN appeals for CA, and to ensure state and federal regulatory and NCQA accreditation standards are met. Primary duties may include, but are not limited to:

Maintains and coordinates staff activities to achieve departmental and corporate goals to improve service to customers/providers and assures regulatory compliance.

Performs monthly audits, IRR audits, and monitors productivity standards and retraining as needed.

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.

Hires, trains, coaches, counsels, and evaluates performance of direct reports. Qualifications 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.

BA/BS preferred.

Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

RN degree strongly preferred. Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2019 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.REQNUMBER: PS39226