Anthem, Inc. Manager I Grievance/Appeals in Reno, Nevada
SHIFT: Day Job
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon 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 care companies and a Fortune Top 50 Company.
The Manager, Grievance/Appeals will be responsible for management oversight of receipt, investigation and processing associated with member/provider quality of care grievances. 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.
This position may work from any Anthem office.
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.
Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Registered Nurse with Quality of Care review experience is required.
Medicare experience required.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. 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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