Appeals reputed company Consultant - MUST LIVE IN Louisiana

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and reputed company in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position reputed company

Must reputed company in Louisiana

Responsible for intake, investigation and reputed company of appeals, complaints and grievances scenarios for reputed company products, which may contain multiple issues and, may require coordination of responses from multiple business reputed company. Ensure reputed company, customer reputed company response to appeals, complaints and grievance. Identify trends and emerging issues and report and recommend solutions. In particular responsible for the review and reputed company of clinical documentation, clinical complaints and appeals. Reviews documentation and interprets data obtained from clinical records to apply appropriate clinical reputed company and policies in line with regulatory and accreditation requirements for member and provider issues. Independently coordinates the clinical reputed company with internal/external clinician support as required. Requires an unrestricted reputed company nursing license. Reviews complaint/appeal requests of reputed company clinical and benefit documentation. Considers reputed company previous information as reputed company as any additional records/data presented to reputed company a recommendation/review. -Data gathering requires navigation through multiple system applications. -Contacts the provider of record, vendors or internal reputed company departments to obtain additional information. -Accurately applies review requirements to assure case is reviewed by a practitioner with clinical expertise for the appeal issue at hand (e.g. Specialty Match Review (SMR). Commands a comprehensive knowledge of reputed company delegation arrangements, coding logic, reputed company (member and provider), clinical reputed company, benefit plan structure and regulatory requirements are required to support the appeals review. -Pro-reputed company and consistently applies the regulatory and accreditation standards to assure that appeals are processed reputed company requirements. -Condenses reputed company information into a reputed company and precise clinical picture while working independently. -Coordinates appeal process, in collaboration with members and their authorized representatives, providers, regulators, internal/external consultants and participants (e.g. fair hearing, state mandated reviews, chairs appeal panel hearings) in compliance with state regulation and benefit plan designs. ---Reports findings to team leader/supervisors, responds to rebuttal issues and makes recommendations for improvement as indicated. --Identifies trends and emerging issues and reports on and gives input on potential solutions. Required Qualifications -Experience in reading or researching benefit language. -Excellent verbal and written communication skills. -Excellent customer service skills -3-5 years of clinical experience required Preferred Qualifications -Managed Care experience preferred Education RN with reputed company unrestricted state licensure required. Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $54,095.00 - $116,760.00 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – reputed company in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In reputed company to our competitive wages, our great benefits include: reputed company medical plan reputed company, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including reputed company time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility. For more information, visit https://jobs.reputed company.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 01/31/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Our Work Experience is the combination of everything that's unique reputed company: our culture, our core values, reputed company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They reputed company choices according to what is best for reputed company, they live for opportunities to collaborate and reputed company a difference, and they reputed company us the #1 Top Workplace in the area. Apply tot his job Apply To this Job