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Specialist, Appeals & Grievances


PayCompetitive
LocationLong Beach/California
Employment typeFull-Time

This job is now closed

  • Job Description

      Req#: 300001375210001
      Employer Industry: Healthcare Services

      Why consider this job opportunity:
      - Opportunity for career advancement and growth within the organization
      - Competitive benefits and compensation package
      - Supportive and collaborative work environment
      - Chance to make a positive impact on member and provider experiences
      - Engaging work that involves resolving appeals and grievances

      What to Expect (Job Responsibilities):
      - Conduct comprehensive research and resolution of appeals, disputes, grievances, and complaints from members and providers
      - Analyze claims appeals and grievances to determine outcomes using support systems
      - Request and review medical records and detailed bills to formulate appropriate responses
      - Communicate with members and providers through written and verbal correspondence
      - Prepare appeal summaries and document findings in accordance with regulatory requirements

      What is Required (Qualifications):
      - High School Diploma or equivalency
      - Minimum 2 years of operational managed care experience (call center, appeals, or claims environment)
      - Health claims processing background, including coordination of benefits, subrogation, 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):
      - Experience in a healthcare-related service environment
      - Knowledge of regulatory guidelines for appeals and denials

      #HealthcareServices #MemberExperience #CareerOpportunity #ClaimsProcessing #ManagedCare

      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

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