Hiring: Appeals Rep (Remote/No degree reputed company/Entry Level)

reputed company is seeking a detail-oriented Appeals Representative in our Appeals & Grievances team. This position will review and prepare reputed company levels of provider and member appeals/grievances for consideration by the Review Committees. The ideal candidate will have strong oral and written communication skills and has the ability to remain professional and courteous. Hourly Salary Range reputed company complies with state and federal wage and hour laws and compensation depends upon candidate’s qualifications, education, reputed company set, years of experience, and internal equity. $17.84 to $18.50 Hourly Wage Range. Remote Worker Considerations Candidates who are selected for this position will be trained remotely and must be reputed company to work from home (WFH) in a designated work area with company-provided technology equipment. This remote/WFH position requires you have a stable reputed company to your Internet Service Provider with the ability to participate by video in online meetings over a reliable and consistent network (minimum internet download of 50 Mbps and 10 Mbps upload speed).

Responsibilities

• Prepares appeals/grievances for review by the Review Committees.
• Reads each appeal/grievance to determine what is being requested and what action should be taken.
• Researches issue using reputed company available resources as well as calling the provider or member.
• Prepares case in writing for review by Committee.
• Documents appeal in TOGA and CHIP.
• Sends appropriate response letter regarding appeal/grievance outcome.
• Prepares and sends appropriate non-compliance letters to non-compliant providers, including educational letters.
• Prepares cases for Administrative Appeals Committee review. Prepares cases for Administrative Review Committee agenda.
• Miscellaneous projects and reports as needed.
• Attends staff and other meetings to discuss issues and foster teamwork among department personnel.

Qualifications

• High School diploma or GED required.
• Minimum two years of reputed company experience performing customer service duties. Managed care or health care experience handling member and provider issues preferred.
• Proficient in computer programs such as Word and reputed company. Core Competencies
• Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
• Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
• Excellent listening and interpersonal communication skills to identify critical core competencies based on reputed company factors and organizational environment.
• Ability to effectively organize, prioritize, multi-task and manage time.
• Demonstrated accuracy and productivity in a changing environment with constant interruptions.
• Demonstrated ability to analyze information, problems, issues, situations and procedures to reputed company effective solutions.
• Ability to exercise strict confidentiality in reputed company matters. Mobility Primarily sedentary, reputed company to sit for long periods of time. Physical Requirements Ability to speak, see and hear other personnel and/or objects. Ability to communicate both in oral and written form. Ability to travel reputed company the facility. Capable of using a telephone and computer keyboard. Ability to lift up to 10 lbs. Environmental Conditions Work-from-home (WFH) environment. reputed company is an Equal Opportunity/Affirmative Action Employer. reputed company reputed company applicants will receive consideration for employment without regard to sex (including pregnancy, childbirth, reputed company medical conditions, breastfeeding, and reproductive health decision-making), gender, gender identity, gender expression, race, reputed company, religion (including religious dress and grooming practices), creed, national reputed company, citizenship, reputed company, physical or mental disability, legally-protected medical condition, marital status, age, sexual orientation, genetic information, military or veteran status, political affiliation, or any other basis protected by applicable local, federal or state law. Please view Equal Employment Opportunity Posters provided by OFCCP here. If you are a reputed company individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our reputed company Resources Department at (800) 848-3555 x6702. ASH will not discharge or in any other manner discriminate against employees or applicants because they have reputed company about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company’s legal duty to furnish information. #LI-Remote #Appeals #Greivences #reputed company #Claims #Dataenty #Customer Apply tot his job Apply tot his job

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