Description
We're building a world of health around every individual , shaping a more connected, convenient, and compassionate health experience.
This position supports the daily processing of appeals in the Commercial Member Clinical Appeals (CMCA). Job functions include completing appeals determination letters, intake and launching of expedited requests, verbal expedited notifications/determinations, updating systems, completing reporting as necessary, supporting the panel hearing process, working collaboratively with clinical support staff, triage of faxes, and movement of cases in the Complaints and Appeals Tracking System (CATS).
Responsibilities
- Complete appeals determination letters
- Intake and launch expedited requests
- Make verbal expedited notifications and determinations
- Update systems and complete reporting as necessary
- Support the panel hearing process
- Collaborate with clinical support staff (Medical Directors, Nurses, Providers, etc.)
- Triage faxes and move cases in the Complaints and Appeals Tracking System (CATS)
Requirements
- Familiarity with medical terminology
- Strong written and verbal communication skills
- Ability to multi-task
- Proficiency in basic computer skills, including Microsoft Office Suite
Preferred Qualifications
- Knowledge of appeals process or appeals experience
- Prior experience working in a medical setting
Education
- High School Diploma
Anticipated Weekly Hours
- 40 hours per week
Time Type
- Full-time
Pay Range
- $18.50 - $38.82 per hour
Benefits
- Comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources