Grievance & Appeals Coordinator

Elevance Health•Indianapolis, IN

3d•$23 - $35•Remote

About The Position

Grievance & Appeals Coordinator Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law The Grievance & Appeals Coordinator is responsible for investigating and reviewing customer grievances and appeals regarding provision of service and benefit coverage issues. Triages clinical and non-clinical inquiries, grievances and appeals, prepares case files for member grievance committees/hearings. How you will make an impact: Summarizes and presents essential information for the clinical specialist or medical/dental director and legal counsel. Responds to oral and written complaints sent to the Office of the Chairman, President or Vice President complaints. Ensures appropriate resolution to inquiries, grievances and appeals within specified timeframes established by either regulatory/accreditation agencies or customer needs. Contacts members to gather information and communicate disposition of case. Documents interactions. Generates written correspondence to members, providers and regulatory agencies. Identifies barriers to customer satisfaction and recommends actions to address operational challenges. Pursues ongoing education/training on benefits/services to ensure accurate resolution of grievances and appeals, and overall industry knowledge and development (i.e. HIAA, LOMA, etc.). Operates a PC/image station to obtain and extract information. Documents information, activities and changes in the database.

Requirements

HS Diploma or equivalent
4 years progressively complex experience working in grievances and appeals; or any combination of education and experience which would provide an equivalent background.

Nice To Haves

Proficient in computer skills preferred.

Responsibilities

Investigating and reviewing customer grievances and appeals regarding provision of service and benefit coverage issues
Triages clinical and non-clinical inquiries, grievances and appeals
Prepares case files for member grievance committees/hearings
Summarizes and presents essential information for the clinical specialist or medical/dental director and legal counsel
Responds to oral and written complaints sent to the Office of the Chairman, President or Vice President complaints
Ensures appropriate resolution to inquiries, grievances and appeals within specified timeframes established by either regulatory/accreditation agencies or customer needs
Contacts members to gather information and communicate disposition of case
Documents interactions
Generates written correspondence to members, providers and regulatory agencies
Identifies barriers to customer satisfaction and recommends actions to address operational challenges
Pursues ongoing education/training on benefits/services to ensure accurate resolution of grievances and appeals, and overall industry knowledge and development (i.e. HIAA, LOMA, etc.)
Operates a PC/image station to obtain and extract information
Documents information, activities and changes in the database