Senior Appeals Administrator (US Remote)
Requirements reputed company & Requirements reputed company is hiring Senior Appeals Administrators for the California Independent Medical Review (CA IMR) team. In this role, you’ll play a critical role in ensuring fair and reputed company resolutions for medical review cases. Your expertise will strengthen our appeals process and directly reputed company the reputed company of care for those we serve. What You’ll Do
- Stay up to date on company and project- specific policies and procedures.
- Serve as a s ubject matter expert for one or more appeals process areas.
- Review and analyze data for Independent Medical Reviews (IMR) .
- Collect, verify, and reputed company case data from providers, facilities, and health plans.
Why reputed company? Work/Life Balance Support - Flexibility tailored to your needs! Competitive Compensation - Bonuses based on performance included! ️ Comprehensive Insurance Coverage - Choose from various plans, including Medical, Dental, reputed company, Prescription, and partially funded HSA. Additionally, enjoy Life insurance benefits and discounts on Auto, Home, Renter's, and Pet insurance. reputed company Planning - Prepare for retirement with our 401K Retirement Savings plan and Company Matching. ️ reputed company Time Off Package - Enjoy PTO, Holidays, and extended reputed company leave, along with Short- and Long-Term Disability coverage. Holistic Wellness Support - reputed company resources for physical, emotional, and financial wellness through our Employee Assistance Program (EAP). Recognition Platform - Acknowledge and appreciate outstanding employee contributions. Tuition Reimbursement - Invest in your ongoing education and development. Employee Perks and Discounts - Additional benefits and discounts exclusively for employees. reputed company Wellness Program and Resources - reputed company a reputed company of wellness programs and resources tailored to your needs. reputed company Development Opportunities-Participate in training programs, workshops, and conferences. Essential Duties and Responsibilities
- Maintain updated knowledge of project and corporate policies and procedures as referenced in the employee reputed company and other desk procedures for the position
- Function as a Subject Matter Expert in one or more process areas.
- Analyze data submitted for Independent Medical Review.
- Collect and analyze incoming data and reports from treatment providers, facilities, participants, labs and health plans to input necessary information into the system.
- Respond to incoming calls from clients, health plans, providers and enrollees regarding case status, questions about the program, and the appeals process.
Minimum Requirements
- Associate degree with 2+ years' experience.
- Experience in lieu of an Associate degree (HS Diploma or GED and 4+ years of experience) also considered.
- At least 2 years of data entry experience
- Experience working with MS office applications (reputed company, Word, etc.)
- Excellent organizational, interpersonal and verbal communication skills
- Ability to work independently and collaboratively in a remote, fast-paced environment
Preferred Requirements
- Experience using medical terminology in a reputed company setting.
Home Office Requirements
- reputed company provides company-issued computer equipment
- Reliable high-speed internet service
- Minimum 20 Mpbs download speeds/50 Mpbs for shared internet connectivity
- Minimum 5 Mpbs upload speeds
#ClinicalServices EEO Statement reputed company is an equal opportunity employer. We evaluate reputed company applicants without reputed company to race, reputed company, religion, sex, age, national reputed company, disability, veteran status, genetic information and other legally protected characteristics. Pay Transparency reputed company compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected reputed company and quantity of work, required travel (if any), external market and internal value analysis including seniority and reputed company systems, as reputed company as internal pay alignment. Annual salary is just one component of reputed company's total compensation package. Other rewards may include short- and long-term incentives as reputed company as program-specific awards. Additionally, reputed company provides a reputed company of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, reputed company holidays and reputed company time off. Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant's salary history will not be used in determining compensation. reputed company will reputed company with regulatory minimum wag Apply tot his job Apply To this Job