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Job Description
- Req#: 25-26555
Employer Industry: Healthcare Consulting
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Work remotely from anywhere in the U.S.
- Competitive salary based on experience
- Supportive and collaborative work environment
- Chance to make a positive impact on the appeals process in the health insurance industry
What to Expect (Job Responsibilities):
- Conduct initial intake and analysis of appeals/grievances correspondence, determining next steps with minimal supervision
- Research contractual benefits, limitations, and claims to assist in the review of appeals and grievances
- Utilize professional communication to assist in responses for appeals and reconsiderations based on regulatory requirements
- Interact regularly with internal and external stakeholders while maintaining confidentiality of medical information
- Participate in monthly meetings to address quality appeal research and improve the intake/entry process
What is Required (Qualifications):
- Minimum educational requirement: High School Diploma or GED
- 5 years of experience in managed care, healthcare, or insurance payer environment, with at least 2 years in Appeals Management
- Must have experience with GuidingCare
- Strong research and problem-solving skills
- Ability to work independently with minimal supervision
How to Stand Out (Preferred Qualifications):
- College degree
- Experience leading, training, coaching, and mentoring less experienced team members
- Excellent organizational and analytical skills
- Knowledge and understanding of medical terminology
#HealthcareConsulting #AppealsManagement #RemoteWork #CareerGrowth #InsuranceIndustry
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