Remote Jobs
Specialist, Appeals & Grievances
What's your preference?
Job Description
- Req#: 300001520104407
Employer Industry: Managed Care Services
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Competitive benefits and compensation package
- Engaging work environment focused on compliance and regulatory standards
- Chance to make a positive impact on healthcare claims processing
- Supportive team atmosphere with a focus on collaboration
What to Expect (Job Responsibilities):
- Conduct comprehensive research and resolution of Provider No Surprises Act cases in compliance with CMS standards
- Review and analyze claims using support systems to determine outcomes for Provider No Surprise Act cases
- Request and assess medical records, notes, and bills to formulate conclusions
- Maintain claims production standards set by the department
- Prepare correspondence related to Provider No Surprise Act cases and document findings accurately
What is Required (Qualifications):
- At least 2 years of managed care experience in a call center, appeals, and/or claims environment
- Health claims processing experience, including coordination of benefits (COB) and eligibility criteria
- Experience with Medicaid and Medicare claims denials and appeals processing
- Strong organizational and time management skills to manage multiple projects
- Effective verbal and written communication skills
How to Stand Out (Preferred Qualifications):
- Customer/provider experience in a managed care organization or medical office/hospital setting
- Completion of a healthcare-related vocational program in health care (e.g., certified coder, billing, or medical assistant)
#ManagedCare #HealthcareClaims #CareerOpportunity #CompetitiveBenefits #RegulatoryCompliance
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
The best remote jobs for you
Notice
Talentify is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Talentify provides reasonable accommodations to qualified applicants with disabilities, including disabled veterans. Request assistance at accessibility@talentify.io or 407-000-0000.
Federal law requires every new hire to complete Form I-9 and present proof of identity and U.S. work eligibility.
An Automated Employment Decision Tool (AEDT) will score your job-related skills and responses. Bias-audit & data-use details: www.talentify.io/bias-audit-report. NYC applicants may request an alternative process or accommodation at aedt@talentify.io or 407-000-0000.