Manager I Grievance/Appeals - Anthem, Inc (California)

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., it’s a

powerful combination, and the foundation upon which we’re 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 benefits companies and a Fortune Top 50

Company.

Manager I

Grievance/Appeals-in office, any Anthem location

Responsible for management oversight of receipt, investigation and processing

associated with Medicare Part C and Part D member/provider appeals in a health

plan setting

Primary duties may include, but are not limited to:

Monitors, trends and

analyzes Part C and/or Part D appeals and grievances data for submission to

appropriate parties.

Serves as expert resource and mentor to Part C and/or D appeals and grievances unit

and other departments for complex issues and interpretation of

regulatory standards.

May perform internal audits of Part C and/or Part D appeals and grievances process.

Ensures Part C and/or Part

D appeals, are resolved within regulatory timeframes.

Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Demonstrated ability to apply CMS guidance for Part C and/or Part D appeals to

operational processes.

Conducts CMS universe reviews and

participates/leads audits as required.

Requires:

BA/BS preferred.

3-5 years Medicare Part C and/or D appeals leadership, supervisory, or

management experience in a health plan setting.

Experience with CMS audits and CMS universe data is required.

Must have strong knowledge of CMS Part C and/or Part D appeals and grievances

guidance.

MS Office product experience is required (Word, Excel, PowerPoint).

Requires strong oral, written and interpersonal communication skills,

problem-solving skills, facilitation skills, and analytical skills.

Anthem, Inc. is ranked as one of

America’s Most Admired Companies among health insurers by Fortune magazine and

is a 2019 DiversityInc magazine Top 50 Company for Diversity. To learn more

about our company and apply, please visit us at careers.antheminc.com. An Equal

Opportunity Employer/Disability/Veteran.

REQNUMBER: PS41001



* This article was originally published here

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