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Associate Specialist, Appeals & Grievances
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Job Description
- Req#: 300001914375545
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Supportive and collaborative work environment
- Chance to make a positive impact on member and provider satisfaction
- Competitive benefits and compensation package
- Engaging work that involves problem-solving and coordination with various departments
What to Expect (Job Responsibilities):
- Review and resolve member and provider complaints in compliance with CMS standards
- Enter denials and requests for appeals into the information system
- Research claims issues using available systems and resources
- Prepare letters and responses to member appeals and grievances
- Collaborate with provider and member services to address balance bill issues
What is Required (Qualifications):
- At least 1 year of experience in claims and/or customer/provider service in a healthcare setting
- Strong organizational and time management skills
- Effective verbal and written communication skills
- Proficiency in Microsoft Office suite and applicable software programs
- Ability to manage multiple projects and tasks to meet internal deadlines
How to Stand Out (Preferred Qualifications):
- Experience in a managed care organization (Medicaid, Medicare, Marketplace, or other government-sponsored programs)
- Completion of a healthcare-related vocational program (e.g., certified coder, billing, or medical assistant)
#HealthcareServices #ClaimsSupport #CareerOpportunity #ProblemSolving #CustomerService
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