Job
Description
Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.SM
The Appeals Representative Associate is responsible for providing expertise or general support to teams in reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances.
Responsibilities:
* Research and resolve written complaints and complex or multi-issue provider complaints submitted by consumers and physicians/providers.
* Communicate with appropriate parties regarding appeals and grievance issues, implications and decisions.
* Analyze and identify trends for appeals and grievances.
* Apply knowledge/skills to basic, repeated activities.
* Respond to standard requests and solve routine problems by following established procedures.
* Work with others as part of a team and have work reviewed by others.
Qualifications
Requirements:
* High School Diploma or GED
* 1+ year of Customer Service Experience in a call center environment analyzing and solving customer problems OR 1+ year of experience in a Corporate environment
* Beginner level of experience with MS Word and Excel.
* Ability to work overtime as needed
Assets:
* Experience with Healthcare/Medicare Terminology
* Managed Care and previous Appeals/Grievances experience