Employer Industry: Healthcare Insurance

Why Consider this Job Opportunity:
- Competitive benefits and compensation package
- 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
- Opportunity to work with Medicaid and Medicare claims denials and appeals processing
- Strong focus on regulatory compliance

What to Expect (Job Responsibilities):
- Review and resolve member and provider complaints in accordance with established standards and requirements
- Conduct comprehensive research and resolution of appeals, disputes, grievances, and complaints
- Utilize support systems to determine appeal and grievance outcomes
- Request and review medical records, notes, and detailed bills to formulate conclusions and determine response
- Prepare appeal summaries, correspondence, and document findings

What is Required (Qualifications):
- High School Diploma or equivalency
- Minimum 2 years operational managed care experience in a call center, appeals, or claims environment
- Background in health claims processing, including coordination of benefits and eligibility criteria
- Familiarity with Medicaid and Medicare claims denials and appeals processing
- Strong verbal and written communication skills

How to Stand Out (Preferred Qualifications):
- 0-2 years of experience in healthcare insurance as an Rx Technician or Customer Service Representative

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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.