WARNING: Please beware of phishing scams that solicit interviews or promote work-at-home opportunities, some of which may pose as legitimate companies. Elevance Health requires a completed online application for consideration of employment for any position. We will never ask you for a credit card, send you a check, or ask you for payment as part of consideration for employment.Manager I – Grievance & Appeals - NGS
Job Family: Claims
Type: Full time
Date Posted:Apr 04, 2024
Anticipated End Date:Apr 19, 2024
Reference: JR109580
Location:
PA, HARRISBURG
TX, DENISON
MD, BALTIMORE
WI, Waukesha
FL, MIAMI
IN, INDIANAPOLIS
OH, CINCINNATI
VA, RICHMOND
KY, LOUISVILLE
TX, GRAND PRAIRIE
NY, EAST SYRACUSE
MI, DEARBORN
TN, NASHVILLE
MN, GILBERT
LA, METAIRIE
GA, MIDLAND
NV, LAS VEGAS
TX, HOUSTON
VA, NORFOLK
MO, ST LOUIS
NC, CARY
WV, CHARLESTON
DE, WILMINGTON
OH, MASON
OH, SEVEN HILLS
RI, SMITHFIELD
MA, HINGHAM
NV, LAS VEGAS
NC, WINSTON
ME, SOUTH PORTLAND
GA, ATLANTA
OH, COLUMBUS
FL, TAMPA
KY, SHELBYVILLE
IA, W DES MOINES
VA, ROANOKE
DescriptionManager I – Grievance & Appeals - NGSLocations: This position will work a hybrid model (in the office a minimum of 4 times per month). The ideal candidate will live within 50 miles of one of our NGS or Elevance Health PulsePoint locations.National Government Services is a proud member of Elevance Health’s family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs.The Manager I – Grievance & Appeals is responsible for the management oversight of receipt, investigation and processing associated with member/provider grievance and appeals.How you will make an impact:
Monitors, trends and analyzes grievance and appeals data for submission to appropriate parties.
Serves as clinical resource expert and mentor to unit and other departments for complex issues and interpretation of regulatory standards.
May perform internal audits of grievance and appeals process.
Ensures appeals and grievances are resolved within regulatory timeframes.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Minimum Requirements:
Requires a minimum of 3 years leadership experience in grievance & appeals, claims or customer services in the healthcare industry; or any combination of education and experience which would provide an equivalent background.
This position is part of our NGS (National Government Services) division which, per CMS TDL 190275, requires foreign national applicants meet the residency requirement of living in the United States at least three of the past five years.
Preferred Skills, Capabilities and Experiences:
Prior experience working with Medicare is strongly preferred.
Prior experience in Grievance & Appeals or Claims highly preferred.
Previous leadership experience 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.If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a 'sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed .For candidates working in person or remotely in the below locations, the salary range for this specific position is $70,240 to $110,628Locations: California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJIn 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.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.Who We AreElevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.How We WorkAt Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.EEO is the LawEqual Opportunity Employer / Disability / VeteranPlease use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.
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Full-time