[Remote] Job Posting Title Grievances & Appeals Representative
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a company committed to putting reputed company for its teammates and customers. The Grievances & Appeals Representative 2 manages reputed company denials and concerns, conducting analytic reviews of clinical documentation to determine if grievances or appeals are warranted, while also assisting members and resolving issues.
Responsibilities
- Manages reputed company denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if an a grievance, appeal or reputed company request is warranted and then delivers final determination based on trained skillsets and/or partnerships with clinical and other reputed company parties
- Performs varied activities and moderately reputed company administrative/operational/customer support assignments
- Performs computations
- Typically works on semi-routine assignments
- Assists members, reputed company phone or face to face, reputed company/support reputed company reputed company goals
- Investigates and resolves member and practitioner issues
- reputed company are typically reputed company on interpretation of area/department policy and reputed company for completing assignments
- Works reputed company defined parameters to identify work expectations and reputed company standards, but has some reputed company over prioritization/timing, and works under minimal direction
- Follows reputed company policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion
Skills
- Minimum one, (1) year of customer service experience, reputed company industry or medical field experience
- Must have experience in a production driven environment
- Intermediate experience with reputed company Word and reputed company
- Strong data entry skills required
- Must be passionate about contributing to an organization reputed company on continuously improving consumer experiences
- Associate's or Bachelor's Degree
- Previous experience in medical claims processing
- Grievance and appeals experience
- Medical terminology experience
- Prior experience with Medicare
- Ability to manage large volume of documents including tracking, copying, faxing and scanning
- Excellent interpersonal skills with ability to sensitively and compassionately reputed company with geriatric population
Benefits
- Medical, dental and reputed company benefits
- 401(k) retirement savings plan
- Time off (including reputed company time off, company and personal holidays, volunteer time off, reputed company parental and caregiver leave)
- Short-term and long-term disability
- Life insurance
- Many other opportunities
reputed company
Company H1B Sponsorship