Anthem, Inc. Manager I Grievance/Appeals in Miami, Florida
SHIFT: Day Job
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater 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
Location: Remote with access to an Anthem office location.
Responsible for management oversight of receipt, investigation and processing associated with member/provider grievance and appeals.
Primary duties may include, but are not limited to:
Monitors, trends and analyzes grievance and appeals data for submission to appropriate parties.
Serves as clinical resource expert and mentor to unit and other departments for complex issues and interpretation of regulatory standards.
May perform internal audits of grievance and appeals process.
Ensures appeals and grievances are resolved within regulatory timeframes.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Requires a minimum of 3 years leadership experience in grievance & appeals, claims or customer services in the healthcare industry; or any combination of education and experience which would provide an equivalent background. BA/BS preferred. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact firstname.lastname@example.org for assistance.