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SCA Appeals Representative I
Elevance HealthResponsible for reviewing and processing healthcare grievances and appeals requests. Ensuring compliance with external and internal policies while delivering optimal service to members and providers.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in reviewing and processing grievances and appeals, with a strong understanding of medical coding, terminology, and the claims process. Proficient in business writing and effective communication across departments.
Highest-signal resume keywords
Grievances And Appeals ExperienceMedical Coding FamiliarityBusiness Writing ProficiencyUnderstanding Of Provider NetworksClaims Process Knowledge
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Grievance ProcessingAppeal AnalysisMedical TerminologyClaims ManagementResearch Skills
Soft Skills
Effective CommunicationInterdepartmental Liaison
Certifications & Qualifications
High School DiplomaGED
Industry Keywords
Medical Management ProcessCustomer Service
About the role
Key responsibilities & impact- Responsible for reviewing, analyzing, and processing non-complex pre and post service grievances and appeals requests
- Utilizes guidelines and review tools to conduct extensive research and analyze the grievance and appeal issue(s)
- Routes summaries and information to nursing and/or medical staff for review
- Serves as a liaison between grievances & appeals and/or medical management, legal, and/or service operations and other internal departments
Requirements
What you’ll need- Requires a High school diploma or GED
- minimum of 1 year 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
Benefits
Comp & perks- 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