Grievance & Appeals Auditor I/II (Multiple positions) - Midland - 31820

Company: anthem
Location: Midland
Posted on: June 12, 2021

Job Description:

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GRIEVANCE & APPEALS AUDITOR I/II (MULTIPLE POSITIONS)

Location: Midland, GA Job Family: Quality Req #: PS48356-2425 Date Posted: Jun 5, 2021

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., its a powerful combination, and the foundation upon which were 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.

As a Grievance and Appeals Auditor at Anthem, you will take pride in providing insights to mitigate customer abrasion and reduce business risk.

We are seeking individuals who have experience with auditing, grievance and appeals, claims processing, regulatory compliance, and the California Department of Managed Health Care.

Join our innovative team and make a difference in the lives of our customers by providing your valuable insights through the auditing, identification of root cause and solutions.

**This position is posted as a job family and the selected candidate will be placed into the job level G&A Auditor I or II commensurate with their experience**

G&A Auditor I

G&A Auditor I is responsible for post completion examination of grievances and appeals in multiple states.

Primary duties may include, but are not limited to:

* Reviews case to determine applicability of, and compliance with, federal and state regulations, enterprise policies and procedures and all related accreditation standards. * Assess whether the case was appropriately handled as a clinical or administrative request and was correctly processed to avoid prompt pay penalties. * Evaluates urgency of clinical situation to assess appropriate handling, determine if sufficient records were obtained, and review medical records and medical policies to determine if correct criterion has been utilized in each review. * Reviews case documentation to assess appropriate system entries have been made and that the step-by-step process is sufficient to mitigate risk associated with regulatory reviews, accreditation reviews, and potential litigation. * Assists management in process improvement strategies to achieve business objectives. * Prepares audit findings and recommendations for G&A associates and management each month. * Identifies and communicates error trends to improve overall quality of enterprise G&A team. * Associates at this level handle routine audits and may receive guidance from G&A Auditor IIs.

G&A Auditor II

G&A Auditor II is responsible for post completion examination of grievances and appeals in multiple states.

Primary duties may include, but are not limited to:

* Reviews case to determine applicability of, and compliance with, federal and state regulations, enterprise policies and procedures and all related accreditation standards. * Reviews case to assess whether it was appropriately handled as a clinical or administrative request and was correctly processed to avoid prompt pay penalties. * Evaluates urgency of clinical situation to assess appropriate handling, determine if sufficient records were obtained, and review medical records and medical policies to determine if correct criterion has been utilized in each review. * Reviews case documentation to assess appropriate system entries have been made and that the step-by-step process is sufficient to mitigate risk associated with regulatory reviews, accreditation reviews, and potential litigation. * Assists management in process improvement strategies to achieve business objectives. * Prepares audit findings and recommendations for G&A associates and management each month. * Identifies and communicates error trends to improve overall quality of enterprise G&A team. * Associates at this level handle routine to complex audits and function as subject matter experts.

Qualifications

G&A Auditor I

Requires a BA/BS Degree, a minimum of 1 year of grievance and appeals experience; or any combination of education and experience which would provide an equivalent background.

G&A Auditor II

Requires a BA/BS degree, a minimum of 2 years of grievance and appeals experience; or any combination of education and experience which would provide an equivalent background.

Applicable to Colorado Applicants Only

Hourly Pay Range*: $ 23.31/hour - $ 31.79 $/hour

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

* The hourly or salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. 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 ofcompensation 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 Companys sole discretion, consistent with the law.

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.

Anthem, Inc. is ranked as one of Americas 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. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem. Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem.

Keywords: anthem, Columbus , Grievance & Appeals Auditor I/II (Multiple positions) - Midland - 31820, Other , Midland, Georgia