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Manager I Grievance/Appeals

Location:
Job Family: Claims
Req #: PS41003
Date Posted: Jan 19, 2021

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your 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.

  

Manager I Grievance/Appeals-in office, any Anthem location

 
Responsible for management oversight of receipt, investigation and processing associated with Medicare Part C and Part D member/provider appeals in a health plan setting
Primary duties may include, but are not limited to:

Monitors, trends and analyzes Part C and/or Part D appeals and grievances data for submission to appropriate parties.
Serves as expert resource and mentor to Part C and/or D appeals and grievances unit and other departments for complex issues and interpretation of
regulatory standards.
May perform internal audits of Part C and/or Part D appeals and grievances process.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Demonstrated ability to apply CMS guidance for Part C and/or Part D appeals to operational processes.

Conducts CMS universe reviews and participates/leads audits as required.

 

Requires:

 

BA/BS preferred.
3-5 years Medicare Part C and/or D health plan appeals leadership, supervisory, or management experience in a health plan setting.
Experience with CMS audits and CMS universe data is required.
Must have strong knowledge of CMS Part C and/or Part D appeals and grievances guidance.
MS Office product experience is required (Word, Excel, PowerPoint).
Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

 

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.

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