Job Details

This range is provided by Artech L.L.C.. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.Location:Corona, CA / Portland, OR - RemoteDuration:12+ Months ContractPay Range:$30.00/hr - $35.00/hr on W2Candidate Location Requirement:Within 100 miles of mentioned location.Job Description:Required Level of Education: HS Diploma but bachelor's is preferred.Experience required: 6 years customer service, heavy writing and speaking with customers over the phone. Microsoft Excel and Word. Healthcare environment is a plus. BlueShield, Aetna, Healthcare providers (this is a huge plus).Expected Shift:Monday-Friday, 8:30am-5pm with opportunities for overtime.Interview Process:1 phone interview (Teams preferred if possible).Top Daily Responsibilities:Research and respond to member grievances and appealsTop (3) Required Skills Candidate Should Have:Background in grievance and appeals case processing.Strong organizational and time management skills.Ability to multi-task in a fast-paced environment.Additional Skills Preferred:Strong knowledge of federal & state regulations and Medicare/Medi-Caid regulations.Ability to compose high quality, detailed written communication.Excellent interpersonal, verbal and written communication skills.Additional Job Description:Responsible for handling the review process for grievances, appeals, or denials including investigating, preparing and presenting appropriate materials for review. Resolves member concerns in partnership with internal and external departments while ensuring compliance with regulatory rules and timeframes.Essential Functions:Participates in handling the grievances, appeals/denials process. Ensures appeals are processed in accordance with regulations, compliance standards and policies and procedures. Meets timeframes for performance while balancing the need to produce high-quality work related to complex and sensitive member issues.Investigates all issues, including collection of appropriate data, preparation and presentation of documents to decision makers. Informs members or their authorized representatives, physicians and other stakeholders of Health Plan's determinations.Collaborates with internal staff, other MS Departments, managers, and physicians to seek resolution on issues and cases affecting members while ensuring compliance, documentation and enhancing members' experience. Ensures integrity of departmental database by thorough, timely and accurate entry.Mentors others in preparation for positions of increased responsibility. Participates in departmental meetings, trainings and audits as requested. Answers questions and manages members on existing / open cases.Seniority Level:Mid-Senior levelEmployment Type:ContractJob Function:Administrative and General BusinessHospitals and Health Care#J-18808-Ljbffr