Grievances and Appeals Representative 4 - Remote/WAH EST

Profile

Description

Responsibilities

This position can be in office or work at home in EST or CST and will provide coverage for eastern time zone hours. Weekend work required. Schedules will be from Thursday - Monday.

The Grievances & Appeals Representative 4 assists members, further/support quality related goals. Reviews the level 1 appeals cases and ensures that information is correct and then forwards to CMS entity for further review. Investigates and resolves member and practitioner issues.


Decisions are regarding the daily priorities for an administrative work group and/or external vendors including coordinating work activities and monitoring progress towards schedules/goals, and is the primary administrative owner of a main process, program, product or technology.
Works within broad guidelines with little oversight.


Required Qualifications


Must be able to work an 8 hour shift from Thursday through Monday.
Strong data entry skills required
1-3 years of customer service experience
Strong proficiency with Microsoft Word and Excel
Must have experience in a production driven environment
Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Work at Home/Remote Requirements
Must ensure designated work area is free from distractions during work hours and virtual meetings
Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required


Preferred Qualifications


Associate's or Bachelor's Degree
Experience with electronic inventory management - able to complete assigned cases in a specified time frame.
Previous inbound call center or related customer service experience
2 - 4 years of grievance and appeals experience
CAS, PAHub and MedHOK experience strongly preferred
Previous experience processing medical claims
Bilingual (English and Spanish); with the ability to read, write, and speak English and Spanish


Scheduled Weekly Hours

40

Company info

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