Elevance Health Jobs

SCA Appeals Representative I

Locations: PA-Harrisburg, IN-Indianapolis, ME-South Portland, TX-Denison, NY-East Syracuse. This is a virtual position. The ideal candidate must live within 50 miles of one of our NGS Elevance Health Pulse Point locations listed on the requisition.

National Government Services is a proud member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs.

Pay/Location: the pay for this position varies by location, is set by the government, and is non-negotiable.

The pay is as follows:

• Indianapolis, Indiana - $18.15

• East Syracuse, New York - $18.15

• Harrisburg, Pennsylvania - $17.25

• Denison, Texas - $17.25

• South Portland, ME - $17.25

The SCA Appeals Representative I position is an entry-level position in the NGS Appeals Department that reviews analyzes and processes non-complex pre-service and post-service grievances and appeals requests from customer types (i.e. member, provider, regulatory, and third party) and multiple products, (Part A & B) related to clinical and non-clinical services, quality of service, and quality of care issues to include executive and regulatory grievances.

How you will make an impact:

• Reviews analyzes, and processes non-complex grievances and appeals by external accreditation and regulatory requirements, internal policies, and claims events requiring adaptation of written response in clear, understandable language.

• Utilizes guidelines and review tools to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route to nursing and/or medical staff for review.

• The grievance and appeal work is subject to applicable accreditation and regulatory standards and requirements.

• As such, the analyst will strictly follow department guidelines and tools to conduct their reviews.

• Analyzes and renders determinations on assigned non-complex grievance and appeal issues and completes the respective written communication documents to convey the determination.

• Responsibilities exclude conducting any utilization or medical management review activities that require the interpretation of clinical information.

• The analyst may serve as a liaison between grievances & and appeals and /or medical management, legal, and/or service operations, and other internal departments.

Minimum Requirements:

• Requires a High school diploma or GED; up to 2 years experience working in grievances and appeals, claims, or customer service or any combination of education and/or experience which would provide an equivalent background.

This position is part of our NGS (National Government Services) division which, per CMS TDL 190275, requires foreign national applicants meet the residency requirement of living in the United States at least three of the past five years.

Preferred Experience, Skills, and Capabilities:

• Familiarity with medical coding and medical terminology demonstrated business writing proficiency, understanding of provider networks, the medical management process, claims process, all of the company's internal business processes, and internal local technology strongly preferred.

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $18.15.

Locations: California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJ

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

• The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.