Appeals Specialist

 **Please make sure your application is complete, including your education, employment history, and any other applicable sections. Initial screening is based on the minimum requirements as defined in the job posting, such as education, experience, licenses, and certifications.  Your experience should also address the knowledge, skills and abilities needed for the role. Incomplete applications will not be considered.**

 

*This position is located Remote United States*

 

Position Purpose:

Researches and responds to inquiries from providers, suppliers, beneficiaries, health plans, or others involved in the appeals/dispute process. May conduct phone calls with appellants for the purpose of scheduling phone discussions with the company decision maker. 

 

Essential Responsibilities:

• Provides customer service and researches and responds to inquiries received by phone, fax, mail, or email timely and accurately.
• Interprets requests and determines appropriate response or course of action to bring to resolution with minimal assistance.
• Conducts research using online federal regulations, reviews contract policy and guidelines to complete an accurate and well-supported decision and/or response.
• Screens receipts to determine the issue addressed in the correspondence and address timely which may involve forwarding cases to the appropriate person or entity timely.
• Logs receipts and enters into database.

 

 

Minimum Qualifications

 

Education

• High School Diploma or equivalent

 

 

Experience

• Three (3) years of general office experience

• College education or technical training in administration, business, or related areas may be substituted for experience on a year per year basis. (Education requirements may be satisfied by full-time education or the prorated part-time equivalent.)

• One (1) year of Medicare Qualified Independent Contractor appeals OR One (1) year of professional business writing experience in the healthcare, customer service or legal industries

• Managed Care, preferred
• Resided in the United States for a minimum of three (3) years out of the last five (5) years (Per Contract Requirement)

 

 

Benefits

C2C offers an excellent benefits package, including:

• Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance
• Section 125 plan
• 401K
• Competitive salary
• License/credentials reimbursement
• Tuition Reimbursement

 

EOE Vet/Disability