Remote Jobs
Appeals Specialist I (Remote)
5 days agoWhat's your preference?
Job Description
- Req#: 21658
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Salary up to $76,032
- Comprehensive benefits package, including various incentive programs and 401k contribution plans
- Opportunity for career advancement and growth within the organization
- Work remotely from within the greater Baltimore metropolitan area
- Supportive and collaborative work environment
- Chance to make a positive impact on the appeals and grievance processes for clients
What to Expect (Job Responsibilities):
- Prioritize, research, and analyze all pertinent information for appeals and grievance requests
- Utilize professional written and verbal communication to assist in responses to all appeals and grievances
- Assist Supervisor and Appeals Specialists II and III with unit projects and related duties
- Communicate with stakeholders while maintaining confidentiality of medical information
- Participate in monthly meetings to discuss quality and workflow improvements
What is Required (Qualifications):
- High School Diploma or GED
- Minimum of 3 years' experience in managed care, healthcare, or insurance payer environments
- Knowledge and understanding of medical terminology
- Strong organizational, analytical, verbal, and written communication skills
- Ability to meet established deadlines and handle multiple customer service demands
How to Stand Out (Preferred Qualifications):
- College degree
- Previous experience with government programs enrollees (e.g., Maryland Medicaid; Medical Advantage) in a healthcare payer organization
- Knowledge of the employer's system, Member/Provider Service, Claims, or Care Management experience
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