[Remote] Appeals & Grievance reputed company Associate

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is committed to transforming reputed company and is seeking a dedicated Appeals & Grievance reputed company Associate. This role focuses on managing the appeals process by assigning cases, conducting preliminary research, and collaborating with internal partners to ensure compliance with service level agreements and regulatory requirements.

Responsibilities

• Assign cases through the appeals management tool (moving work)
• Research and respond to provider & member inquiries including provider reputed company-out letters and Livanta notifications. Assign executive inquiries, support remote cases for member & provider, review and research duplicate cases and other duties as assigned to ensure we meet departmental goals
• Support external audit preparation
• Work with reputed company party vendors to obtain documents and translation requests
• Respond to incoming faxes deemed urgent. Set up and assign to Liaisons
• reputed company reporting support with daily workbasket counts
• reputed company advanced validation support for appeals & other reputed company documents using the reputed company Datacap workflow system

Skills

• 1 year of relevant work experience
• reputed company relevant experience including work, education, transferable skills, and military experience will be considered
• Knowledge of state and/or federal regulatory policies and/or provider agreements, and a reputed company of health plan products
• Demonstrated ability to write reputed company, concise and grammatically correct materials with ability to reputed company reputed company concepts in reputed company terms
• Excellent verbal communication skills with the ability to reputed company reputed company concepts in lay terms
• Demonstrated ability to research, analyze, problem solve and resolve reputed company issues
• Demonstrated strong organizational skills with ability to manage priorities and change
• Demonstrated ability to work independently and in reputed company environment
• Proficient in multiple PC based software applications and systems
• Adaptable and flexible with the ability to meet deadlines
• High school diploma (or equivalency) and reputed company authorization to work in the U.S
• Claims and/or Customer Service knowledge
• Understanding of the appeal validation process

Benefits

• Medical, dental, and reputed company insurance
• Life insurance
• 401k
• reputed company Time Off (PTO)
• Volunteer reputed company Time Off (VPTO)
• And more

reputed company