Grievance/Appeals Analyst II (FEP)

Anticipated End Date: 2026-09-11 Position Title: Grievance/Appeals Analyst II (FEP) Job Description: Grievance/Appeals Analyst II Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Grievance/Appeals Analyst II is responsible for reviewing, analyzing and processing non-complex and some complex pre service and post service grievances and appeals requests in the Enterprise Grievance & Appeals Department from customer types (i.e. member, provider, regulatory, and third party) and multiple products (i.e. HMO, POS, PPO, EPO, CDHP, and indemnity) 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: 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, and completion of the respective written communication documents to convey the determination. The file review components of the URAC and NCQA accreditations are must pass items to achieve the accreditation. The analyst may serve as a liaison between grievances & appeals and /or medical management, legal, and/or service operations and other internal departments.   Obtaining cooperation from these other areas requires an awareness of their functions and necessitates the development and maintenance of relationships to include instilling an awareness of our customer expectations and responses.   Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information. Identify opportunities for improvement and any provide support and assistance to G & A Analyst I associates as needed.

HS diploma or equivalent. Minimum of 1 year of Grievance & Appeals analyst experience and a minimum of 3 years experience working in grievances and appeals, claims, or customer service; or any combination of education and experience which would provide an equivalent background. Preferred Skills, Capabilities and Experiences Associates degree preferred. Federal Employees Program experience preferred. For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $21.22/hr to $35.20/hr.  Locations: New York, Virginia   In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company.  The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category