161 applicants

Company

Elevance Health · 3 days ago

Mgr II Grievance/Appeals-Data Analytics

Indianapolis, IN

Full-time

Hybrid

Senior Level

5+ years exp

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Responsibilities

Coordinates Grievance and Appeals Committee Meetings and Member Panel Hearings.

Leads grievance and appeals in regulated audits.

Analyzes large data sets using advanced knowledge of ETL data processing methods.

Designs and builds ad hoc and recurring reports and data visualizations using data modeling tools like Power Pivot.

Develops predictive models to forecast business needs and meet key objectives.

Serves as a resource for complex issues and interpretation of claims, provider contracts and data, eligibility, member contracts, benefits, clinical decisions, pharmacy on pre-service and post service appeals and grievances related to non-clinical and clinical services, quality of service and quality of care issues including executive and regulatory grievances.

Oversees and implements new subsystems, procedures, techniques and supports digital automation objectives.

Architects SharePoint lists and manages permissions to meet user needs using site governance best practices.

Analyzes and develops strategies by achieving performance thresholds within budgetary guidelines.

Monitors trends and analyzes grievance and appeals data to identify and recommend plan and policy changes and to ensure state and federal regulatory compliance and resolution within the regulatory timeframes.

Ensures programs support overall QI program and meet regulatory compliance/accreditation and the company standards.

Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

GrievanceAppeals ManagementETL Data ProcessingHealthcare Industry ExperienceManagement ExperienceRegulatory ComplianceSQLData VisualizationPredictive ModelingSharePoint ManagementBudget ManagementCoaching

Required

Bachelor’s degree

Minimum of 5+ years grievance & appeals experience

Minimum of 3 years of management experience in the healthcare industry

Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location

Preferred

Advanced knowledge of ETL data processing using query language such as SQL or Power Query

Benefits

Merit increases

Paid holidays

Paid Time Off

Incentive bonus programs

Medical

Dental

Vision

Short and long term disability benefits

401(k) +match

Stock purchase plan

Life insurance

Wellness programs

Financial education resources

Company

Elevance Health

Glassdoor

3.6

Elevance Health is an integrated whole-health approach to help people in health journey and address their full range of needs.

Founded in 1944

Indianapolis, Indiana, USA

10,001+ employees

https://www.elevancehealth.com

H1B Sponsorship

Elevance Health has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

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2023 (510)

2022 (370)