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Associate Specialist, Appeals & Grievances
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Job Description
- Req#: 300002369180757
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Competitive compensation and benefits package
- Opportunity for career advancement within the organization
- Supportive and collaborative work environment
- Chance to make a positive impact on member and provider satisfaction
- Engage in meaningful work by resolving healthcare claims issues
What to Expect (Job Responsibilities):
- Enter denials and requests for appeals into the information system and prepare documentation for further review
- Research claims issues utilizing systems and available resources
- Assure timeliness and appropriateness of appeals according to state, federal, and employer guidelines
- Request and obtain medical records, notes, and detailed bills as appropriate for research
- Generate and mail denial letters while collaborating with provider and member services to resolve complaints
What is Required (Qualifications):
- Minimum of 1 year of experience in claims or customer/provider service in a healthcare setting
- Strong customer service skills
- Excellent organizational and time management skills, with the ability to manage multiple projects
- Effective verbal and written communication skills
- Proficiency in Microsoft Office suite and applicable software programs
How to Stand Out (Preferred Qualifications):
- Experience in a managed care organization (Medicaid, Medicare, Marketplace, or other government-sponsored programs) or in a medical office/hospital setting
- Completion of a healthcare-related vocational program (e.g., certified coder, billing, or medical assistant)
#HealthcareServices #ClaimsProcessing #CustomerService #CareerOpportunity #CompetitivePay
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