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Grievance and Appeals Quality Specialist Lead

Anthem, Inc

This is a Full-time position in Placentia, CA posted February 20, 2021.

Description SHIFT: Day JobSCHEDULE: Full-timeYour 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 care companies and a Fortune Top 50 Company.Grievance and Appeals Quality Specialist Lead Must be able to report to an Anthem office.Responsible for providing oversight for the development and maintenance of training programs within the department.

Primary duties may include, but are not limited to:+ Oversees and assists associates responsible for resolving and monitoring Medicare Complaints, Appeals and Grievances.

Participates in the delivery of coaching and feedback.

+ Performs quality control functions, including the timely and accurate completion of required audits.

+ Responds to inquiries and system changes.

+ Identifies, investigates, and resolves audit processing issues, and provides oversight and assistance with procedure guidelines.

+ Resolves Rebuttal Issues for the Quality Auditors.

+ Develops and delivers training to staff as needed.

+ Provides ongoing feedback to the manager regarding the performance of the Quality Auditors.Requires a BA/BS in Business Administration; 3 or more years of related Appeal and/or Grievance experience in a Medicare Healthplan setting ; or any combination of education and experience, which would provide an equivalent background.

A minimum of 2 years experience as a Quality/Training Specialist preferred.

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.

Anthem, Inc.

is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes.

To learn more about our company and apply, please visit us at

An Equal Opportunity Employer/Disability/Veteran.

Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.REQNUMBER: PS44651-California