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Form of workJob Description
Job Title: Appeals & Grievances Coordinator – Must be US Citizen
Location: 100% remote – EST work hours preferred
Schedule: Monday – Friday (8-hour shift will start between 7am-9am)
Job Description:
Receive, investigate and triage expedited appeal requests received from members/member representatives enrolled in Senior Products. Timely assignment of cases is critical to ensure member's appeal rights are processed in accordance with regulatory agencies' standards, including the Center for Medicare and Medicaid Services (CMS) and National Committee for Quality Assurance (NCQA).
Job Responsibilities:
- Claims research and processing (more of researching why the claim was denied than actually research into the claim)
- Processing appeals in the system
- Authorization lookups
- Processing health insurance claims
Job Qualifications:
- High School Degree required
- College degree and/or extensive experience would be considered
- At least 1 year of experience in health insurance claims
- Outbound call experience (though not a large part of this job) is a good to have and appeals required
- Nice to have: A customer service background and experience, not necessarily in the healthcare field
- Medicaid experience desired
