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Elevance Health
Indianapolis
**Title: Grievance/Appeals Analyst I** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations. The **Grievance/Appeals Analyst I** is an entry level position in the Enterprise Grievance & Appeals Department that reviews, analyzes and processes non-compl
Job Source: Elevance HealthHumana
Indianapolis
**Become a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The Corporate Medical Director works on problems of diverse scope and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical in
Job Source: HumanaElevance Health
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**Nurse Appeals – Licensed RN Nurse** **Location:** This position will work in a hybrid model (remote and office). Ideal candidates will live in Virginia, Georgia, Florida, Indiana, or Ohio within 50 miles of one of our PulsePoint locations. **Shift:** Monday to Friday from 8:00 am - 5:00 pm ET or Tuesday to Saturday from 8:00 am – 5:00 pm ET (will
Job Source: Elevance HealthDepartment Of The Treasury
Indianapolis, IN, United States
Duties WHAT IS THE APPEALS DIVISION? A description of the business units can be found at: https://www.jobs.irs.gov/about/who/business-divisions Vacancies will be filled in the following specialty areas: Office of Appeals Case and Operations Support Planning Policy Quality & Analysis 15-Vacancies- Will be filled in any Appeals location listed within
Job Source: Department Of The TreasuryTrustmark
Indianapolis
Trustmark’s mission is to improve wellbeing – for everyone. It is a mission grounded in a belief in equality and born from our caring culture. It is a culture we can only realize by building trust. Trust established by ensuring associates feel respected, valued and heard. At Trustmark, you’ll work collaboratively to transform lives and help people,
Job Source: TrustmarkHealthEdge Software Inc
Indianapolis
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Job Source: HealthEdge Software IncRenaissance
Indianapolis
When you join Renaissance®, you join a global leader in pre-K–12 education technology! Renaissance’s solutions help educators analyze, customize, and plan personalized learning paths for students, allowing time for what matters—creating energizing learning experiences in the classroom. Our fiercely passionate employees and educational partners have
Job Source: RenaissanceIntermountain Health
Indianapolis
**Job Description:** Responsible for drafting, advancing, and maintaining all legal documents, letters and correspondence for appealing with third party and governmental payers to obtain reimbursement including handling difficult, hard to collect accounts that have been deemed by the insurance company to be unpayable. Scope This is a regional role
Job Source: Intermountain HealthIndianapolis
**Title: Grievance/Appeals Analyst II**
**Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.
The **Grievance/Appeals Analyst II** will be responsible for reviewing, analyzing and processing non-complex and some complex pre service and post service grievances and appeals requests in the Enterprise Grievance & Appeals Department from customer types (i.e. member, provider, regulatory, and third party) and multiple products (i.e. HMO, POS, PPO, EPO, CDHP, and indemnity) 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:**
+ 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, and completion of the respective written communication documents to convey the determination.
+ The file review components of the URAC and NCQA accreditations are must pass items to achieve the accreditation.
+ The analyst may serve as a liaison between grievances & appeals and /or medical management, legal, and/or service operations and other internal departments.
+ Obtaining cooperation from these other areas requires an awareness of their functions and necessitates the development and maintenance of relationships to include instilling an awareness of our customer expectations and responses.
+ Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information.
+ Identify opportunities for improvement and any provide support and assistance to G&A Analyst I associates as needed.
**Minimum Requirements**
+ HS diploma or equivalent
+ Minimum of 1 year of Grievance & Appeals analyst experience
+ Minimum of 3 years experience working in grievances and appeals, claims, or customer service; or any combination of education and experience which would provide an equivalent background.
**Preferred Qualifications**
+ Associates degree preferred.
+ Demonstrated business writing proficiency, understanding of provider networks, the medical management process, claims process, the company's internal business processes, and internal local technology is strongly preferred
For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Email Alert for Grievance/Appeals Analyst II_ jobs in Indianapolis
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