[Remote] Appeals & Grievance Liaison Associate

Note: The job is a remote job and is open to candidates in USA. reputed company is committed to transforming reputed company and is seeking a dedicated Appeals & Grievance Liaison 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
• Provide 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 variety of health plan products
• Demonstrated ability to write clear, concise and grammatically correct materials with ability to express reputed company concepts in simple terms
• Excellent verbal communication skills with the ability to express 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 a team 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 legal 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
• Paid Time Off (PTO)
• Volunteer Paid Time Off (VPTO)
• And more

Company Overview