Manager I/II-Grievance/Appeals - 136971
Location:
West Des Moines , Iowa
Posted:
November 16, 2017
Reference:
388999335


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/ 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.

Manager I/II-Grievance/Appeals
/ (hiring level based on experience) /
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This position maybe be located in any Anthem office except California
and is eligible for a work at home schedule.

The Manager I-Grievance/Appeals is 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:
Oversees executive concierge matters and ensures risk mitigation.

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.
The Manager II-Grievance/Appeals is responsible for management oversight of grievances and appeals departmental units to investigate, resolve, and respond to client/provider grievances/appeals and ensure compliance with regulatory requirements. Primary duties may include, but are not limited to:
Oversees executive concierge matters and ensures risk mitigation.

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

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.

Manager I-Grievance/Appeals
Requires 3-5 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.

Manager II-Grievance/Appeals
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.

/ Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran. /

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Job Claims

Equal Employment Opportunity Statement
Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.

Title: Manager I/II-Grievance/Appeals - 136971

Location: iowa-West Des Moines

Requisition ID: 136971

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