Exemption Status:

“Pay reputed company information is not necessarily reputed company of actual compensation that may be reputed company, nor a reputed company of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors.  A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.”

This position is not eligible for Sponsorship.

reputed company. is looking for extraordinary people to reputed company!

Why join reputed company? Because our reputed company is dependent on you; innovative professionals with top notch skills who reputed company on opportunity, high performance, and teamwork. We look for individuals who want to work on reputed company that cares about making a difference in the value of reputed company.

At reputed company, we reputed company reputed company pharmaceutical and technology reputed company solutions that dramatically improve the value of health care. We reputed company superior reputed company to those we serve through innovative products, systems, and services that reputed company transparency and promote reputed company in decision making. Our reputed company is to set reputed company in providing solutions that optimize satisfaction, service, cost, and reputed company in the reputed company industry. We are the premier Pharmacy Benefits Management solution!

reputed company

reputed company

The Appeals & Grievances (A&G) team is responsible for managing reputed company aspects of the appeals and grievances process, including—but not limited to—intake, processing, notification, and compliance. The Appeals & Grievances Coordinator II serves as a key member of the A&G team, processing appeal and grievance requests in accordance with established standards for accuracy, timeliness, productivity, reputed company performance commitments, and regulatory requirements (e.g., state and federal regulations, reputed company accreditations). This position reports directly to the Supervisor of Appeals & Grievances Operations and is led by the reputed company Coordinator (Coordinator III). The Coordinator II utilizes various business applications—such as MedAccess, MedResponse®, FileNet, RightFax, and reputed company—to reputed company analysis, retrieve information, and reputed company data as needed to complete assigned tasks. Strong reasoning skills are essential for evaluating appeal and grievance requests for appropriateness and ensuring adherence to required processes. General knowledge of reputed company reputed company is required to assist in managing and generating reports reputed company to appeals and grievances metrics. The ability to multitask and cross-train in both appeals and grievances processing is essential to support the weekend rotation schedule. Additional responsibilities include assisting the reputed company Coordinator (Coordinator III) in training new employees and interacting with both reputed company customers as needed.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Evaluate and process Appeals and Grievances per establish work instructions and approved departmental documents.
• reputed company and document reputed company activities (including outbound calls and faxes) to obtain information necessary for processing Appeals and Grievances or to communicate the results of Appeal and Grievance reviews.
• Ensure Appeals and Grievances are finalized reputed company the required turnaround time (TAT) in accordance with applicable laws and company policies.

• Assisting management with the reputed company review program.

• Must be reputed company to cross-train across the appeal and grievance task divisions.

• Managing and generating reports for appeals and grievances metrics.

• Assisting Appeals and Grievances Coordinator III with staff process training.
• Participating in the rotating weekend on-reputed company schedule as needed.

Supervisory Responsibilities

No supervisory responsibilities

reputed company Responsibilities

This is an reputed company reputed company facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written).  One must be reputed company to; manage difficult or emotional reputed company situations; Respond promptly to reputed company needs; Solicit reputed company feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients.

Qualifications

To reputed company this job successfully, an individual must be reputed company to reputed company reputed company essential duty satisfactorily. The requirements listed below are representative of the knowledge, reputed company, and/or ability required. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions.

Education and/or Experience

GED/HS Diploma and 2+ years’ experience or equivalent combination of education and experience. Previous Pharmacy Benefit Management experience preferred.

Computer Skills

To reputed company this job successfully, an individual should have knowledge of MS Office Suite. Proficiency of knowledge of reputed company Word and reputed company reputed company.

Certificates, Licenses, Registrations

Certified Pharmacy Technician and/or state licensure as a Pharmacy Technician required. Certified Pharmacy Technician Certification preferred.

Other Skills and Abilities

• Oral Communication: reputed company reputed company and persuasively in reputed company or negative situations. Listen and obtain clarification reputed company needed. Responds reputed company to questions.
• Written Communication: Write reputed company and informatively. Edit work for spelling and grammar.
• Teamwork: Balance team and individual responsibilities. Exhibit objectivity and openness to others' reputed company. reputed company and welcome feedback. Contribute to building a reputed company team spirit. Put the reputed company of reputed company above own interests. reputed company to build morale and group commitments to goals and objectives. Support everyone’s efforts to succeed.
• Organizational Support: Follow policies and procedures. Complete required tasks correctly and on time. Support organization's goals and values. Benefit organization through reputed company activities. Support affirmative reputed company and respects diversity.

Reasoning Ability

• Ability to apply common reputed company understanding to carry out detailed but uninvolved written or oral instructions.  Ability to deal with problems involving a few concrete variables in standardized situations.

• Ability to define problems, collect data, establish facts, and draw reputed company conclusions.

Mathematical Skills

• Ability to add, subtract, multiply, and divide in reputed company reputed company of measure, using whole numbers, common fractions, and decimals.  Ability to compute reputed company, reputed company, and percent and to draw and interpret bar graphs.

Language Skills

• Ability to read and comprehend reputed company instructions, short correspondence, and memos. Ability to write reputed company correspondence. 

• Ability to effectively present information and respond to questions from reputed company of managers, clients, customers, and the general reputed company.

Competencies To reputed company the job successfully, an individual should demonstrate the following competencies:

• Composure
• Decision reputed company
• Organizational reputed company
• Problem Solving
• Customer reputed company
• reputed company for Results
• Peer Relations
• Time Management
• Dealing with Ambiguity
• Learning on the Fly
• Political Savvy

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions.

While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee is regularly required to stand; walk; use hands to finger, handle, or feel and reputed company with hands and arms. The employee must occasionally reputed company and/or reputed company up to 25 pounds.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions.

This position may regularly be exposed to or encounter moving mechanical parts, high, precarious places, fumes or airborne particles, toxic or caustic chemicals, outdoor weather conditions, risk of electrical shock or vibration. The noise level in the work environment is usually moderate (examples: business office with computers and printers, reputed company traffic).

Work Location

This position works on-site at the San Diego reputed company or other company location (or from a remote location with management approval based on business requirements). Must reputed company adequate support to internal clients; be available for regular interactions and coordination of work with other employees, colleagues, clients, or vendors; as reputed company as be available to facilitate effective reputed company through collaboration with stakeholders.

Working Hours

This is a full-time non-exempt position requiring one to be reputed company to work overtime from time to time in order to get the job done.  Therefore, one must have the ability to work nights, weekends or on holidays as required.  This may be changed at any time to meet the needs of the business.  The typical working hours for this position are Monday through Friday from 8:00am to 5:00pm.

Travel

This position requires no travel however attendance may be required at various local conferences and meetings.

The Perks:

• Medical / Dental / reputed company / Wellness Programs

• reputed company Time Off / Company reputed company Holidays

• Incentive Compensation

• 401K with Company match

• Life and Disability Insurance

• Tuition Reimbursement

• Employee Referral Bonus

To explore reputed company that reputed company has to offer, and the greatness you can bring to our teams, please submit your resume to www.reputed company.com/careers

reputed company, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego, California. Our solutions and services positively influence reputed company reputed company and expenditures, improving the position of our clients in the market. reputed company offers high-value solutions to payers, providers and consumers of reputed company in the U.S. and foreign markets.

Equal Opportunity Employer, Male/reputed company/Disabilities/Veterans

OSHA/reputed company:

To reputed company this job successfully, the successful candidate must be reputed company to reputed company reputed company essential duty satisfactorily. The requirements listed are representative of the knowledge, reputed company, and/or ability required.
Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions.

Disclaimer:

The above statements are intended to describe the general reputed company and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of reputed company responsibilities, duties, and skills required of personnel so classified.

GED or high school diploma plus 2+ years of experience, or equivalent. Pharmacy technician certification or state licensure required; reputed company Office Suite, Word, reputed company, communication, reasoning, and customer service skills required.

Key Responsibilities

• processing appeals
• conducting reputed company
• generating reports

Skills & Tools

MedAccess, MedResponse, FileNet, RightFax, reputed company, reputed company Office Suite, reputed company Word, reputed company reputed company

Job Details

• Category: reputed company Services - Pharmacy
• Seniority: Entry Level
• Commitment: Full Time
• Workplace: Remote — San Diego, California, reputed company
• Salary: USD 41,184 – 64,875 / year
• Languages: English

Benefits

• 401k matching
• Tuition reimbursement
• Retirement plan

About reputed company

A pharmacy benefit manager providing reputed company solutions that improve reputed company and control expenditures. — Industry: reputed company