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Job Description
- Req#: 25-26555
Employer Industry: Technology and Business Consulting
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Work remotely from anywhere within the continental U.S.
- Supportive and collaborative work environment
- Chance to make a positive impact in the appeals and grievances process
- Competitive salary based on experience
What to Expect (Job Responsibilities):
- Independently research contractual benefits, limitations, and exclusions to assist in the review of appeals, grievances, and reconsiderations
- Utilize professional written and verbal communication to respond to appeals and reconsiderations based on State and Federal requirements
- Interact regularly with internal and external stakeholders while maintaining confidentiality of medical information
- Collect, organize, and track information to facilitate the processing of appeals and grievances
- Participate in monthly meetings to discuss quality appeal research and problem-solve issues in the appeal intake process
What is Required (Qualifications):
- Minimum of 2 years of experience in Appeals Management
- 5 years of experience in managed care, healthcare, or insurance payor environment
- High School Diploma or GED
- Must have experience with GuidingCare
- Ability to work independently with minimal supervision
How to Stand Out (Preferred Qualifications):
- College Degree
- Strong research and problem-solving skills
- Ability to lead, train, coach, and mentor less experienced team members
- Excellent organizational and analytical skills
- Knowledge and understanding of medical terminology
#TechnologyConsulting #RemoteWork #CareerAdvancement #HealthInsurance #AppealsManagement
"We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately.
We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer."About the company
Ampcus Inc. is an ISO 20000, ISO 27000, ISO 9001, CMMI DEV/3 SM, and CMMI SVC/3 SM certified global provider of a broad range of Technology and Business consulting services. From strategy to execution, our disciplined yet flexible approach starts and ends with our clients. By listening hard and working harder, client goals become our goals.
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