Process appeals and grievances, analyze, research, and provide comprehensive responses in accordance with established regulatory and accreditation guidelines. Contact customers to gather information and communicate disposition of case. Conduct pertinent research in order to evaluate, respond to, and finalize case. Familiar with standard concepts, practices, and procedures for analyzing, interpreting data and applying contract and regulatory provisions. High School Diploma or GED required. Bachelor’s Degree in English, Communications or related field preferred. Two (2) years customer service experience required. Two (2) years health insurance experience and familiarity with health insurance state and federal regulations preferred. Strong project management skills preferred.

Top 3 Required Skills/Experience –

• Experience handling a large load of work in a fast-paced environment and have computer skills!

• Insurance, Medicare/CMS knowledge

• Customer Service Experience

Required Skills/Experience – The rest of the required skills/experience. Include:

• Writing Letters

• Analytical thinker

• Research Skills

• Multi-task

Preferred Skills/Experience – Optional but preferred skills/experience. Include:

• Grievance and Appeals experience.

• Degree in Healthcare/computer skills

• Experience in analyzing a claim

• Experience in classification between a grievance/appeal/organizational determination.

• Letter writing

• Basic computer skills. How to save a PDF, how to navigate excel, learning new systems

Education/Certifications – Include:

• Healthcare, English,

Category Human Resources

Function HR / Benefits

Req ID JN -122024-121755