Georgia Nurse Claims Anthem Shorted Medical Claim Reviewers Overtime Pay


A Monday complaint fingers Anthem Companies Inc. for violations of the Fair Labor Standards Act (FLSA), claiming that non-exempt employees worked more than 40 hours per week, but only received base pay despite the insurance company’s knowledge that they were working overtime.

The lawsuit explains that the plaintiff, a Georgia woman, worked for Anthem as a Medical Management Nurse from approximately December 2015 to July 2020, partly from the defendant’s Atlanta office, and partly from her home. Medical Management Nurses as well as Utilization Management Nurses, Utilization Review Nurses, Nurse Reviewers, Nurse Reviewer Associates, and others primarily performed “medical necessity reviews,” the filing says. The complaint further explains that those jobs required reviewers to assess “medical authorization requests submitted by healthcare providers against pre-determined guidelines and criteria for insurance coverage and payment purposes.”

The former management nurse argues that she and others similarly situated were paid a salary, but not the overtime pay they were due. The defendant reportedly knew about the plaintiff’s plight because she and others “complained about their long hours and the workload.” When she brought this up to her supervisor, the plaintiff was reportedly told that the workload could not be modified because the company would not be hiring additional workers. 

The complaint also alleges that despite its obligation, Anthem also failed to keep accurate time records for the plaintiff and the proposed FLSA class consisting of Georgia workers who held the aforementioned reviewer roles “during the applicable statutory period.”

The filing states one claim for relief under the FLSA, failure to pay overtime. The plaintiff on behalf of herself and the putative state class seeks unpaid back wages, damages, including liquidated damages, interest, and an award of attorneys’ fees and costs.

The plaintiff is represented by Austin & Sparks P.C. and Nichols Kaster PLLP.