Molina Healthcare
Specialist, Appeals & Grievances (Remote- Must have A&G/Claims experience)
This job is now closed
Job Description
- Req#: 2024398
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
- Strong commitment to Equal Opportunity Employment
- Training provided to enhance skills and knowledge in the field
What to Expect (Job Responsibilities):
- Review and resolve member and provider complaints in accordance with established standards and requirements
- Conduct comprehensive research to determine appeal and grievance outcomes
- Request and review medical records and detailed bills to formulate conclusions and determine appropriate responses
- Contact members and providers through written and verbal communication
- Prepare appeal summaries, correspondence, and document findings accurately and concisely
What is Required (Qualifications):
- High School Diploma or equivalency
- Minimum 2 years of operational managed care experience in a call center, appeals, or claims environment
- Health claims processing background, 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-related service
#HealthcareInsurance #CareerOpportunity #CompetitivePay #TrainingProvided #EqualOpportunityEmployment
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
Molina Healthcare is a managed care company headquartered in Long Beach, California, United States.
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