Position Description:

Positions in this function are responsible for providing expertise or general support to teams in reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances. Communicates with appropriate parties regarding appeals and grievance issues, implications and decisions. Analyzes and identifies trends for all appeals and grievances. May research and resolve written Department of Insurance complaints and complex or multi-issue provider complaints submitted by consumers and physicians/providers.

• An education level of at least a high school diploma or GED


• 2+ years of experience analyzing and solving medical appeals and grievances in an office setting environment using the telephone and computer as the primary instruments to perform job duties


• Proficiency with computers and Windows PC applications (MS Word, Excel, and Email), which includes the ability to learn new and complex computer system applications


• Must be able to work overtime as business needs require


• Medicare experience preferred


• Experience with Healthcare/Medical terminology preferred


• Prior stable work experience


• Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product


• Ability to remain focused and productive each day though tasks may be repetitive


• Authorization to work in the United States


• Available to work 40 hours per week within the operating hours of the site

Physical Requirements and Work Environment:

• Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouse