SCA Appeals Representative I

Elevance Health

. Review, analyze, and process non-complex pre- and post-service grievances and appeals requests .

Posted 10/26/2026full-timeUnited StatesJuniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in processing grievances and appeals, with a strong understanding of medical coding, claims processes, and regulatory requirements. Proficient in business writing and effective communication across various departments.

Highest-signal resume keywords

Grievances And Appeals ProcessingMedical Coding FamiliarityClaims Process UnderstandingBusiness Writing ProficiencyRegulatory Compliance Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Grievances ProcessingAppeals ProcessingClaims AnalysisMedical TerminologyQuality Of Care AssessmentQuality Of Service EvaluationWritten CommunicationResearch SkillsCase SummarizationInternal Business Processes Understanding

Industry Keywords

Part A ProductsPart B ProductsProvider NetworksMedical Management ProcessAccreditation RequirementsRegulatory RequirementsCustomer Service ExperienceClaims EventsNursing LiaisonInternal Local Technology

About the role

Key responsibilities & impact

Review, analyze, and process non-complex pre- and post-service grievances and appeals requests
Process requests from members, providers, regulatory parties, and third parties across Part A and Part B products
Handle clinical and non-clinical services, quality of service, quality of care, executive, and regulatory grievances
Follow external accreditation and regulatory requirements and internal policies
Process claims events requiring written responses
Use guidelines and review tools to research grievance and appeal issues
Analyze pertinent claims and medical records to approve or summarize cases
Route summaries and information to nursing and/or medical staff for review
Follow department guidelines and review tools
Liaise between grievances and appeals, medical management, legal, service operations, and other internal departments

Requirements

What you’ll need

High school diploma or GED
Minimum of 1 year experience working in grievances and appeals, claims, or customer service
Alternatively, any combination of education and/or experience providing an equivalent background
Foreign national applicants must have lived in the United States for at least three of the past five years
Familiarity with medical coding and medical terminology strongly preferred
Business writing proficiency strongly preferred
Understanding of provider networks strongly preferred
Understanding of the medical management process strongly preferred
Understanding of the claims process strongly preferred
Understanding of internal business processes strongly preferred
Understanding of internal local technology strongly preferred

Benefits

Comp & perks

Merit increases
Paid holidays
Paid Time Off
Incentive bonus programs (unless covered by a collective bargaining agreement)
Medical benefits
Dental benefits
Vision benefits
Short-term disability benefits
Long-term disability benefits
401(k) with match
Stock purchase plan
Life insurance
Wellness programs
Financial education resources
Virtual full-time work, except for required in-person training sessions