Senior Appeals Representative

Elevance Health

. Investigate and review customer appeals regarding provision of service and benefit coverage issues .

Posted 11/10/2026full-timeRemote • United StatesSeniorWebsite

Core Competencies

Role fit

Core Competencies

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

Demonstrates expertise in managing grievances and appeals, with a strong understanding of benefits contracts and regulatory compliance. Proficient in verbal and written communication, organizational skills, and providing leadership in a supportive environment.

Highest-signal resume keywords

Grievances And Appeals ManagementRegulatory ComplianceVerbal And Written CommunicationOrganizational SkillsLeadership

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Case File PreparationInquiry ResolutionDocumentation And LoggingResearch And AnalysisCustomer Service

Soft Skills

Interpersonal SkillsProblem-SolvingTeam Guidance

Tools & Technologies

Tracking SystemsPC Proficiency

Industry Keywords

Benefits ContractsMedicare KnowledgeAccreditation StandardsCustomer SatisfactionOperational Challenges

About the role

Key responsibilities & impact

Investigate and review customer appeals regarding provision of service and benefit coverage issues
Triage clinical and non-clinical inquiries, grievances and appeals
Prepare case files for member grievance committees and hearings
Summarize and present essential information to clinical specialists, medical directors and legal counsel
Respond to oral and written complaints
Resolve inquiries, grievances and appeals within regulatory, accreditation or customer-specified timeframes
Contact customers to gather information and communicate case dispositions; document interactions
Generate written correspondence to members, providers and regulatory agencies
Identify barriers to customer satisfaction and recommend actions to address operational challenges
Pursue ongoing education and training on benefits and services
Document and log inquiry, appeal and grievance information in tracking systems
Resolve complex customer issues requiring adapted responses or extensive research
Make administrative exceptions within prescribed guidelines
Investigate, summarize and recommend resolutions for non-clinical cases
Assist grievance and appeals staff with file decisions
Provide direction and guidance to team members
Provide leadership and foster a supportive environment
Perform other related duties as required

Requirements

What you’ll need

High school diploma or equivalent
Minimum 4 years related experience working in grievances and appeals
Or any combination of education and/or experience which would provide an equivalent background
Foreign national applicants must have lived in the United States for at least three of the past five years
Understanding of the application of benefits contracts, pricing, policies and legislative regulations
Verbal and written communication skills
Organizational skills
Interpersonal skills
PC proficiency strongly preferred
Appeals knowledge preferred
Knowledge of Part A and B Medicare preferred
Candidates must reside within a reasonable commuting distance from the posting location(s), unless accommodation is granted as required by law
Certain patient/member-facing roles require vaccination against COVID-19 and Influenza

Benefits

Comp & perks

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