Grievance & Appeals Coordinator

Elevance Health - Meridian, ID

Full-time - Entry Level

Meridian, ID

11-50 employees

Insurance Carriers and Related Activities

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 resolution of issues in compliance with regulatory standards.

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 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 case dispositions.
• 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 equivalent.
• 4 years of progressively complex experience working in grievances and appeals, or a combination of education and experience providing an equivalent background.

Benefits

• Merit increases
• Paid holidays
• Paid Time Off
• Incentive bonus programs
• Medical benefits
• Dental benefits
• Vision benefits
• Short and long term disability benefits
• 401(k) with matching
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources