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Elevance Health - Columbus, GA
posted 2 months ago
About the position
The Grievance & Appeals Coordinator at Elevance Health is responsible for investigating and reviewing customer grievances and appeals related to service provision and benefit coverage. This role involves triaging clinical and non-clinical inquiries, preparing case files for member grievance committees, and ensuring timely resolutions to complaints. The coordinator will also summarize essential information for clinical specialists and legal counsel, document interactions, and recommend actions to improve customer satisfaction.
Responsibilities
- Investigate and review customer grievances and appeals regarding service provision and benefit coverage.
- Triages clinical and non-clinical inquiries, grievances, and appeals.
- Prepare case files for member grievance committees/hearings.
- Summarize and present essential information for clinical specialists or medical/dental directors and legal counsel.
- Respond to oral and written complaints sent to the Office of the Chairman, President, or Vice President.
- Ensure appropriate resolution to inquiries, grievances, and appeals within specified timeframes.
- Contact members to gather information and communicate the disposition of cases; document interactions.
- Generate written correspondence to members, providers, and regulatory agencies.
- Identify barriers to customer satisfaction and recommend actions to address operational challenges.
- Pursue ongoing education/training on benefits/services to ensure accurate resolution of grievances and appeals.
Requirements
- High school diploma or GED.
- 4 years of progressively complex experience working in grievances and appeals or equivalent education and experience.
Benefits
- Employee stock purchase plan
- Paid holidays
- Disability insurance
- Health insurance
- Dental insurance
- Paid time off
- Vision insurance
- 401(k) matching
- Life insurance
