SCA Appeals Rep I (US)
This job is no longer available
There are still lots of open positions. Let's find the one that's right for you.
About The Position
The SCA Appeals Representative I position is an entry-level role in the NGS Appeals Department that reviews, analyzes, and processes non-complex pre-service and post-service grievances and appeals requests from various customer types, including members, providers, regulatory bodies, and third parties. The position requires adherence to external accreditation and regulatory requirements, as well as internal policies. The analyst will conduct extensive research and analyze grievance and appeal issues, utilizing guidelines and review tools to determine outcomes and communicate decisions effectively. Responsibilities exclude conducting any utilization or medical management review activities that require the interpretation of clinical information. The analyst may also serve as a liaison between grievances and appeals and other internal departments.
