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 – Medicare Complaints, Appeals & Grievance – PS47112
Responsible for management oversight of complaints to Medicare (CTMs) and grievances and/or appeals departmental units to investigate, resolve, and respond to client/provider CTMs/grievances/appeals and ensure compliance with regulatory requirements.
Primary duties may include, but are not limited to:
• Maintains and coordinates staff activities to achieve departmental and corporate goals to improve service to customers/providers and assures regulatory compliance.
• Analyzes and develops strategies by achieving performance thresholds within budgetary guidelines.
• Addresses both internal/external customer/provider needs and concerns related to team activities.
• Ensures programs support overall QI program and meets regulatory compliance/accreditation and the company
• standards.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports
Qualifications:
• 2 + years CTM or grievance & appeals experience
• 3-5 years of management experience in the healthcare industry or any combination of education and experience, which would provide an equivalent background.
• BA/BS preferred.
• Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, presentation 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 2018 Diversity Inc. 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
Qualifications
Manager I Grievance/Appeals – Medicare Complaints, Appeals & Grievance – PS47112
Responsible for management oversight of complaints to Medicare (CTMs) and grievances and/or appeals departmental units to investigate, resolve, and respond to client/provider CTMs/grievances/appeals and ensure compliance with regulatory requirements.
Primary duties may include, but are not limited to:
• Maintains and coordinates staff activities to achieve departmental and corporate goals to improve service to customers/providers and assures regulatory compliance.
• Analyzes and develops strategies by achieving performance thresholds within budgetary guidelines.
• Addresses both internal/external customer/provider needs and concerns related to team activities.
• Ensures programs support overall QI program and meets regulatory compliance/accreditation and the company
• standards.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports
Qualifications:
• 2 + years CTM or grievance & appeals experience
• 3-5 years of management experience in the healthcare industry or any combination of education and experience, which would provide an equivalent background.
• BA/BS preferred.
• Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, presentation skills, and analytical skills.
An Equal Opportunity Employer/Disability/Veteran
REQNUMBER: PS47112
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