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　　SCA Appeals Representative I

　　Job Family: SCA > SCA Wage Determination

　　Type: Full time

　　Date Posted:Jan 19, 2024

　　Anticipated End Date:Feb 16, 2024

　　Reference: JR102143

　　Location:

　　PA, HARRISBURG

　　TX, DENISON

　　IN, INDIANAPOLIS

　　ME, SOUTH PORTLAND

　　Description

　　SCA Appeals Representative I

　　Locations: IN-Indianapolis, ME-South Portland, PA-Harrisburg and TX-Denison.

　　Elevance Health supports a hybrid workplace model with pulse point sites (major office) used for collaboration, community, and connection. This position can be primarily virtual, however will be based within 50 miles of a pulse point site listed above.

　　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.

　　This SCA Appeals Representative I is an entry-level position in the NGS Appeals Department. This role 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 (Part A & B) related to clinical and non-clinical services, quality of service, and quality of care issues to include executive and regulatory grievances.

　　How you will make an impact:

　　Reviews analyzes, and processes non-complex grievances and appeals by 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.

　　Analyzes and renders determinations on assigned non-complex grievance and appeal issues and completes 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 & and appeals and /or medical management, legal, and/or service operations, and other internal departments.

　　Pay: The pay for this position varies by location, is set by the government, and is non-negotiable.

　　The pay is as follows:

　　Indianapolis, Indiana - $17.85

　　Harrisburg, Pennsylvania- $17.20

　　Denison, Texas - $17.20

　　South Portland, Maine - $17.20

　　Minimum Requirements

　　Requires a High school diploma or GED; up to 2 years experience working in grievances and appeals, claims, or customer service or any combination of education and/or 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 Experience, Skills, and Capabilities

　　Familiarity with medical coding and medical terminology demonstrated business writing proficiency, understanding of provider networks, the medical management process, claims process, all of the company's internal business processes, and internal local technology strongly preferred.

　　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 Are

　　Elevance 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 Work

　　At 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 [email protected] for assistance.

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　　Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.

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　　Elevance Health, Inc. is anE-verify Employer (https://www.e-verify.gov/sites/default/files/everify/posters/EVerifyParticipationPoster.pdf)

　　Need Assistance?

　　Email us ([email protected])