Nurse Appeals Or Nurse Appeals Sr. (Tues-Sat)

Anthem, Inc. Los Angeles , CA 90009

Posted 1 week ago


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. Location: This position will allow you to work from your home office.

Shift: This posting is for full time, Tuesday thru Saturday; 9am - 5:30pm

Sign on Bonus:$3,000 sign on bonus (Paid upon first pay-cycle after start date. If employment ends prior to 1 year, sign on bonus must be paid back, less applicable taxes)

This Nurse Appeals Nurse Appeals Sr. role will support the Grievances and Appeals within the East, Central and West Regions. This role is responsible for investigating and processing medical necessity appeals requests from members and providers. Primary duties may include, but are not limited to:

  • Conducts investigations and reviews of member and provider medical necessity appeals.

  • Reviews prospective, inpatient, or retrospective medical records of denied services for medical necessity.

  • Extrapolates and summarizes medical information for medical director, consultants and other external review.

  • Prepares recommendations to either uphold or deny appeal and forwards to Medical Director for approval.

  • Ensures that appeals and grievances are resolved timely to meet regulatory timeframes.

  • Documents and logs appeal/grievance information on relevant tracking systems and mainframe systems.

  • Generates written correspondence to providers, members, and regulatory entities.

  • Utilize leadership skills and serves as a subject matter expert for appeals/grievances/quality of care issues and is a resource for clinical and non-clinical team members in expediting the resolution of outstanding issues.


Nurse Appeals:

  • Requires 2 years of experience in a managed care healthcare setting; or any combination of education and experience, which would provide an equivalent background.

  • Current active unrestricted RN license to practice as a health professional within California.

  • AS/BS in Nursing preferred.

Nurse Appeals Sr.:

  • Requires 4 years of experience in a managed care healthcare setting; or any combination of education and experience, which would provide an equivalent background.

  • Current active unrestricted RN license to practice as a health professional within California.

  • AS/BS in Nursing 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.

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Appeals Officer (International Specialist)

Department Of The Treasury

Posted 2 days ago

VIEW JOBS 5/13/2021 12:00:00 AM 2021-08-11T00:00 * Duties Help Duties Summary WHAT IS THE APPEALS DIVISION? Independent by statute, staffed by highly trained professionals who provide mediation for any taxpayer contesting IRS compliance actions. Appeals is the last opportunity for the IRS and a taxpayer to resolve disputes prior to litigation, and ensures that all taxpayers can receive an impartial review of their tax case. See Other Information for Locations. Learn more about this agency Responsibilities WHAT DOES AN APPEALS OFFICER (INTERNATIONAL SPECIALIST) DO? An Appeals Officer (International Specialist) serves as a liaison within Appeals organization and other operating units to resolve and/or advise on international issues. In this role, you will provide assistance and guidance to Appeals Team Case Leaders, Team Managers and Appeals Officers working some of the most technically complex and demanding international issues. As an Appeals Officer (International Specialist) you will: * Conduct Appeals conferences for the settlement/resolution of the largest and most complex international tax issues under the jurisdiction of Appeals. * Review international case files and other information germane to the determination of tax liability. * Analyze case files to determine issues of fact and law. Reconcile apparent factual discrepancies by further investigation, reconstruction, and/or determine what is consistent with all available evidence. * Research case issues to determine and apply the law to the facts presented. Where issues are unclear, you will determine the appropriate resolution based upon relevant factors. Raise new international tax issues when appropriate. * Serve as an "in-house" expert and/or office liaison on international tax issues. When appropriate, serve as either a lead instructor or an instructor for courses or sessions addressing international tax issues. * Organize work, independently identify priorities, apply knowledge and skills to expeditiously and correctly resolve/settle case issues. Compose supporting statements, closing agreements, correspondence, and other written materials. * Display professional demeanor when dealing with taxpayers, representatives, and others encountered during the course of work. Conduct Appeals conferences with dignity, impartiality, and an orderly manner. * Maintain appropriate liaison and professional contact within Appeals and with Compliance, other IRS divisions and Counsel. Confer with Counsel Attorneys on settlement or trial of docketed cases. WHERE CAN I FIND OUT MORE ABOUT OTHER IRS CAREERS? If you want to find out more about IRS careers, visit us on the web at Travel Required Occasional travel - 1 to 5 Nights per Month. Supervisory status No Promotion Potential 13 * Job family (Series) 0930 Hearings And Appeals * Requirements Help Requirements Conditions of Employment * Refer to Other Information * Click "Print Preview" to review the entire announcement before applying. * Must be a U.S. Citizen or National * IRS Employees with Career or Career Conditional Appointments Land Management Eligibles must provide all required documentation to verify eligibility, prior performance, and qualifications for the target position. You can find information on the Land Management Workforce Flexibility Act and eligibility HERE. Land Management Eligibles must compete under competitive merit promotion procedures and meet all applicable requirements as such (time-in-grade restrictions do not apply). Qualifications You must meet the following requirements by the closing date of this announcement. GS-13 LEVEL: You must have at least one year of specialized experience at a level of difficulty and responsibility equivalent to the GS-12 grade level in the Federal service. Specialized experience for this position includes: Applying professional accounting principles, theory, and practices to analyze and interpret accounting books, records, or systems specifically to determine effect on tax liabilities or financial statements; Recognizing and assessing the complexity of accounting or legal issues; Applying professional legal principles, theory, and practices to analyze and interpret legal issues specifically to determine effect on tax liabilities or financial statements; Interpreting the law in situations where there are uncertainties or conflicts in statutes, regulations, case law, precedence or other guidance to determine and apply the appropriate intent of the law in tax situations; Conducting legal research and applying the law to tax situations; Applying knowledge of accounting topics to the resolution of tax issues. Accounting topics include: stockholder equity, income recognition and other special reporting topics; financial characteristics of business entities; journal and ledger entries;; inventory valuation; investments and revenue recognition, auditing standards and generally accepted accounting principles associated with asset and liability measurement and their related effect on net income; and analyzing financial statements; Familiar with litigation procedures and making judgments involving matters of law particularly as they relate to resolving tax disputes. In addition to the above specialized experience includes: Experience reviewing and analyzing tax treaties between the United States and foreign governments to apply and resolve cases relevant to tax laws in foreign countries, economic theory, exchange rates, contract laws, immigration laws, and bank secrecy laws. Experience in applying tax and accounting principles in the resolution of tax disputes. Such topics include one or more of the following: accounting methods and principles used in foreign countries, tax treatment of foreign tax credits, determining taxable income and income exclusions for U. S. Taxpayers living abroad or conducting business in foreign jurisdictions, taxable income determinations for foreign taxpayers conducting business and earning income in the United States, determining assessment and abatement of international penalties and Title 31 penalties. * The experience may have been gained in the public sector, private sector or Volunteer Service. One year of experience refers to full-time work; part-timework is considered on a prorated basis. * To ensure full credit for your work experience, please indicate dates of employment by month/year, and indicate number of hours worked per week, on your resume. In addition to the above requirements, you must meet the following, if applicable: You must have been at the GS-12 level for 52 weeks (time-in-grade requirement). Education Department Of The Treasury Los Angeles CA

Nurse Appeals Or Nurse Appeals Sr. (Tues-Sat)

Anthem, Inc.