Appeals Specialist (Disputes)

Tmf/C2C • Austin, TX

1d • Remote

About The Position

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. This position is located Remote, Anywhere US. Due to being a federal contractor, you may be subject to obtaining and maintaining a public trust security clearance from the federal government.

Requirements

• High School Diploma or equivalent
• Three (3) years of general office experience
• One (1) year of Medicare Qualified Independent Contractor appeals or Veterans Affairs (VA) experience OR One (1) year of professional business writing experience in the healthcare, customer service or legal industries
• Reside in US for last three (3) of five (5) years (Per Contract Requirement)

Nice To Haves

• Customer service, preferred

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.
• Trends receipts/issues and schedules coordination meetings as required.

Benefits

• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED