SCA Appeals Rep I (US)

We need to produce HTML fragment with sections: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections that have real specific content. We must not repeat job title. Remove boilerplate, navigation, EEO, etc. Keep substantive info. Let's parse the posting. Key info: - Location: role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. Alternate locations may be considered if candidates reside within a commuting distance from an office. Note about hybrid/virtual work policy. - About Wellpoint Federal: description. - The SCA Appeals Rep I is Responsible for reviewing, analyzing, and processing non-complex pre and post service grievances and appeals requests from customer types (member, provider, regulatory, third party) and multiple products (Part A & B) related to clinical and non-clinical services, quality of service, quality of care issues to include executive and regulatory grievances. - How You Will Make An Impact: bullet list? It says: Reviews, analyzes, and processes non-complex grievances and appeals in accordance with external accreditation and regulatory requirements as well as internal policies and claims events requiring written responses. 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. Routes summaries and information to nursing and/or medical staff for review. Strictly follows department guidelines and tools to conduct reviews. Serves as a liaison between grievances & appeals and /or medical management, legal, and/or service operations and other internal departments. - Minimum Requirements: High school diploma or GED and a minimum of 1 year experience working in grievances and appeals, claims, or customer service; or any combination of education and/or experience which would provide an equivalent background. Also note: This position is part of Wellpoint Federal division which, per CMS TDL 190275, requires foreign national applicants meet the residency requirement of living in the United States at least three of the past five years. - Preferred Experience, Skills, And Capabilities: Familiarity with medical coding and medical terminology demonstrated business writing proficiency, understanding of provider networks, the medical management process, claims process, all of the company's internal business processes, and internal local technology strongly preferred. - Who We Are: description of Elevance Health. - How We Work: description of hybrid workforce strategy, vaccination requirement, etc. - Benefits: mention "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." - Pay: Not mentioned explicitly. No pay info. So we should NOT include Pay section. - Schedule: Not explicitly mentioned. There's mention of virtual full-time except training, hybrid requirement (once per week onsite). Could be considered schedule info? The instruction: include Schedule section only if posting actually states them. It does mention virtual full-time except required in-person training, and hybrid requirement. That could be considered schedule. However we need to see if it's specific enough: "role enables associates to work virtually full-time, except for required in-person training sessions" and "Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week." That's schedule info. So we could include a Schedule section with that content. - Benefits: we have content. - About the role: we have location description and maybe overview. Could be About the role. - Responsibilities: we have "How You Will Make An Impact" which is essentially responsibilities. - Requirements: Minimum Requirements. - Qualifications: maybe Preferred Experience, Skills, And Capabilities could be Qualifications or Skills. The instruction: Use headings for sections like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We need to decide which to use. We have content for: - About the role: location and maybe description of Wellpoint Federal. - Responsibilities: the impact bullet points. - Requirements: Minimum Requirements. - Qualifications/Skills: Preferred Experience, Skills, And Capabilities (could be Skills). Could also treat as Qualifications. - Benefits: total rewards description. - Schedule: virtual/hybrid schedule. We should not include Pay. We must not include boilerplate like EEO, etc. We must preserve all substantive information, not invent or summarize away detail. So we need to keep the specifics: e.g., "Reviews, analyzes, and processes non-complex grievances and appeals in accordance with external accreditation and regulatory requirements as well as internal policies and claims events requiring written responses." etc. We need to format as HTML: use

for section headings. Use

• for any list of duties/requirements/benefits, and

  for prose. We need to decide what is a list vs prose. The responsibilities are multiple sentences; could be a list. The Minimum Requirements could be a list? It's a sentence with options. Could be a

  . The Preferred Experience could be a list? It's a sentence with many items separated by commas. Could be a

  • each item? Might be better as

    because it's not clearly a list. However instruction: Use

    • for any list of duties/requirements/benefits. So if we treat them as a list, we should use
      • . For responsibilities, we can break into bullet points each sentence. For requirements, maybe one bullet. For benefits, list each benefit. Let's extract responsibilities sentences: 1. Reviews, analyzes, and processes non-complex grievances and appeals in accordance with external accreditation and regulatory requirements as well as internal policies and claims events requiring written responses. 2. 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. 3. Routes summaries and information to nursing and/or medical staff for review. 4. Strictly follows department guidelines and tools to conduct reviews. 5. Serves as a liaison between grievances & appeals and/or medical management, legal, and/or service operations and other internal departments. That's a list. Minimum Requirements: "Requires a High school diploma or GED and a minimum of 1 year experience working in grievances and appeals, claims, or customer service; or any combination of education and/or experience which would provide an equivalent background. This position is part of our Wellpoint Federal division which, per CMS TDL 190275, requires foreign national applicants meet the residency requirement of living in the United States at least three of the past five years." We could make two bullet points: education/experience, and residency requirement. Preferred Experience, Skills, And Capabilities: "Familiarity with medical coding and medical terminology demonstrated business writing proficiency, understanding of provider networks, the medical management process, claims process, all of the company's internal business processes, and internal local technology strongly preferred." That's a bit garbled. Probably means: Familiarity with medical coding and medical terminology; demonstrated business writing proficiency; understanding of provider networks; the medical management process; claims process; all of the company's internal business processes; and internal local technology strongly preferred. We can make a list of those items. Benefits: "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." We can list each benefit. Schedule: Content: "role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. 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 accommodation is granted as required by law." Also later: "Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process." We can combine into a few bullet points or paragraphs. About the role: Could include location description and Wellpoint Federal description. Let's extract: - Location: This role enables associates to work virtually full-time, except for 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 accommodation is granted as required by law. - Wellpoint Federal description: "Wellpoint Federal, a subsidiary of Elevance Health, brings deep industry expertise and healthcare service capabilities to support federal programs. The organization delivers solutions across claims administration, data, and care delivery to help address complex challenges and improve health outcomes for federal populations." - The SCA Appeals Rep I is Responsible for reviewing, analyzing, and processing non-complex pre and post service grievances and appeals requests from customer types (i.e., member, provider, regulatory, and third party) and multiple products (Part A & B) which are related to clinical and non-clinical services, quality of service, and quality of care issues to include executive and regulatory grievances. We could put that in About the role or Responsibilities. But we already have Responsibilities separate. The description of role responsibilities could be in About the role as overview. However we already have responsibilities list. To avoid duplication, we could put the high-level description in About the role, and the detailed responsibilities in Responsibilities. Thus About the role: location + Wellpoint Federal + role purpose (reviewing grievances). That is substantive. Now we need to output HTML fragment only. We'll structure:

        About the role

        ... location description ...

        ... Wellpoint Federal description ...

        ... role purpose ...

        But we could combine into one

        with multiple sentences. However instruction: use

        for prose. So we can have multiple

        elements. Then Responsibilities:

        Responsibilities

        • ...
        ...
        Requirements:

        Requirements

        • High school diploma or GED and a minimum of 1 year experience working in grievances and appeals, claims, or customer service; or any combination of education and/or experience which would provide an equivalent background.
        • Foreign national applicants must meet the residency requirement of living in the United States at least three of the past five years (per CMS TDL 190275).
        Skills (or Qualifications). Let's use

        Skills

        and list items. Skills list: - Familiarity with medical coding and medical terminology - Demonstrated business writing proficiency - Understanding of provider networks - Understanding of the medical management process - Understanding of the claims process - Understanding of all of the company's internal business processes - Familiarity with internal local technology (strongly preferred) We could phrase as bullet points. Benefits:

        Benefits

        • Merit increases
        • Paid holidays
        • Paid Time Off (PTO)
        • Incentive bonus programs (unless covered by a collective bargaining agreement)
        • Medical insurance
        • Dental insurance
        • Vision insurance
        • Short-term disability benefits