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 Grievances & Appeals Risk Analyst I will be responsible for responding to inquiries received from regulatory agencies for one or more states or functions and/or for responding to inquiries/complaints received by executive leadership. Responsible for providing support to legal, management and executive level associates through a variety of assignments and projects which utilize knowledge specific to the company.
How you will make an impact:
Analyzes and evaluates inquiries, complaints, reports, and/or filings.
Prepares and organizes case research, notes, and documents.
Conducts research and analysis, and recommends appropriate course of action and next steps for management review.
Performs fact checking, gathers documents, researches and responds to inquiries and records requests and assists with investigative and discovery activities and processes.
Corresponds with attorneys both internal and external in grievances and appeals regulatory cases.
Minimum Requirements
HS diploma
Minimum of 2 years of G&A or related experience; or any combination of education and experience which would provide an equivalent background.
Preferred Qualifications
BA/BS in a related field preferred.
Paralegal certification and experience preferred.
Claims adjustment experience highly 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.
WGS experience 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.
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $27.95/hr. to $41.93/hr.
Locations: New York
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
