Elevance Health
Manager I – Grievances & Appeals – Provider Disputes
Elevance Health, Los Angeles, California, United States, 90079
Anticipated End Date:
2024-11-22Position Title:
Manager I – Grievances & Appeals – Provider DisputesLocation:
This position will work a hybrid model (in office 1-2 days per week). The ideal candidate will live within 50 miles of one of our Open Access Pulse Points listed in this requisition.Job Description:The Manager I – Grievances & Appeals will be responsible for management oversight of receipt, investigation and processing associated with provider disputes ensuring regulatory compliance, quality, manages inventory and production levels, and operational and plan risk.How you will make an impact:Serves as a functional resource expert and mentor to unit and other departments for complex issues and interpretation of claims, provider contracts and data, eligibility, member contracts, benefits, clinical decisions, pharmacy on pre-service and post service appeals and grievances related to non-clinical and clinical services, quality of service and quality of care issues including executive and regulatory grievances.May perform internal audits of grievances and appeals process.Monitors trends and analyzes grievances and appeals data to identify and recommend plan and policy changes and to ensure state and federal regulatory compliance and resolution within the regulatory timeframes.Hires, trains, coaches, counsels, and evaluates performance of direct reports.Minimum Requirements:Requires a bachelor’s degree and 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.Preferred Skills, Capabilities and Experiences:Experience supervising a production-based preferred.Prior experience with healthcare insurance claims highly preferred.Prior experience working with WGS claims system preferred.Strong communication skills (written and verbal) highly preferred.Strong analytical skills, understands and acts on root cause.Job Level:
ManagerWorkshift:Job Family:
CLM > Claims SupportWho We Are:
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.How We Work:
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact
elevancehealthjobssupport@elevancehealth.com
for assistance.
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2024-11-22Position Title:
Manager I – Grievances & Appeals – Provider DisputesLocation:
This position will work a hybrid model (in office 1-2 days per week). The ideal candidate will live within 50 miles of one of our Open Access Pulse Points listed in this requisition.Job Description:The Manager I – Grievances & Appeals will be responsible for management oversight of receipt, investigation and processing associated with provider disputes ensuring regulatory compliance, quality, manages inventory and production levels, and operational and plan risk.How you will make an impact:Serves as a functional resource expert and mentor to unit and other departments for complex issues and interpretation of claims, provider contracts and data, eligibility, member contracts, benefits, clinical decisions, pharmacy on pre-service and post service appeals and grievances related to non-clinical and clinical services, quality of service and quality of care issues including executive and regulatory grievances.May perform internal audits of grievances and appeals process.Monitors trends and analyzes grievances and appeals data to identify and recommend plan and policy changes and to ensure state and federal regulatory compliance and resolution within the regulatory timeframes.Hires, trains, coaches, counsels, and evaluates performance of direct reports.Minimum Requirements:Requires a bachelor’s degree and 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.Preferred Skills, Capabilities and Experiences:Experience supervising a production-based preferred.Prior experience with healthcare insurance claims highly preferred.Prior experience working with WGS claims system preferred.Strong communication skills (written and verbal) highly preferred.Strong analytical skills, understands and acts on root cause.Job Level:
ManagerWorkshift:Job Family:
CLM > Claims SupportWho We Are:
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.How We Work:
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact
elevancehealthjobssupport@elevancehealth.com
for assistance.
#J-18808-Ljbffr