, Florida


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.


Grievance and Appeals Analyst I

**These positions will be hired to work remotely on a temporary basis due to Covid restrictions.  Eventually, these positions will transition to work from one of our Anthem office locations; therefore, candidates must be within a commutable distance (50 miles) of an Anthem office.  Target locations include: OH, IN, FL, TX, GA, CO, TN.**

This is an entry-level position in the Enterprise Grievance & Appeals Department that reviews, analyzes and processes
non-complex pre-service and post-service grievances and appeals requests 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. Primary duties may include, but are not limited to:

  • Reviews, analyzes, and processes non-complex grievances and appeals in accordance with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, understandable language.
  • 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. The file review components
of the URAC and NCQA accreditations are "must pass" items to achieve the accreditation. They will analyze and
render determinations on assigned non-complex grievance and appeal issues and completion of the respective written
communication documents to convey the determination. Responsibilities exclude conducting any utilization or medical
management review activities that require the interpretation of clinical information. The analyst may serve as a liaison
between grievances & appeals and /or medical management, legal, and/or service operations and other internal

Hours/shift: standard work hours (approx. 8am - 5pm), some weekend hours required (occasional overtime)

Pay: $18.50 - $20.00/hr.


Requires a High school diploma or GED; 3 to 5 years experience working in grievances and appeals, claims, or
customer service, familiarity with medical coding and medical terminology, demonstrated business writing proficiency,
understanding of provider networks, the medical management process, claims process, the company's internal business
processes, and internal local technology; or any combination of education and/or experience which would provide an
equivalent background. For URAC accredited areas the following applies: 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 2018 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.

, Florida

At Anthem, Inc., we believe that our health connects us all. So we focus on being a valued health partner and delivering quality products and services that give members access to the care they need. With more than 100 million people served by our affiliated companies including approximately 40 million enrolled in our family of health plans, we can make a real difference to meet the needs of our diverse customers.

Similar jobs