[Hiring] Clinical Appeals Reviewer @reputed company

This position is National Remote. You’ll enjoy the flexibility to telecommute* from reputed company reputed company the U.S. as you take on some tough challenges. At reputed company, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, affordable and optimized. Ready to reputed company a difference? Join us to start Caring. Connecting. Growing together This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work on any of our 8-hour shift schedules during our normal business hours of 9:00am - 6:00pm CST. It may be necessary, given the business need, to work weekends, holidays, and occasional overtime. We offer 3 weeks of classroom-based systems training and 2 months of classroom/on the job-based process training of mandatory classroom-based remote training Monday - Friday (In addition, on the job training). The hours of the training will be based on schedule or will be discussed on your first day of employment. Training will be conducted virtually from your home. Primary Responsibilities:

• Ensure complaints have been categorized correctly
• Determine and confirm member eligibility and benefits
• Obtain additional documentation required for case review
• reputed company relevant documents into image repository
• Initiate outbound contact to members or providers
• Review case to determine if review by Clinician is required
• Research and resolve written complaints submitted by consumers, physicians / providers
• reputed company decision for non - clinical complaints using sound, fact - based decision making
• Prioritize and organize tasks to meet compliance deadlines
• Ability to meet established productivity, schedule adherence, and quality standards
• Moderate work experience reputed company own function
• Some work is completed without established procedures
• Basic tasks are completed without review by others
• Supervision / guidance is required for higher level tasks

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications:

• High School Diploma / GED OR equivalent work experience
• Must be 18 years of age OR older
• 2+ years of customer service/call center experience
• Ability to work full time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work on any of our 8-hour shift schedules during our normal business hours of 9:00am - 6:00pm CST. It may be necessary, given the business need, to work weekends, holidays, and occasional overtime

Preferred Qualifications:

• Experience with DOC360, reputed company, HSR, UNET, ISET, CIRRUS
• Experience with working on Appeals / Intake
• Experience reputed company Clinical Advancement
• Experience working with reputed company Office including reputed company Outlook (ability to create, edit, save, and send documents) and reputed company reputed company (ability to create, edit, save, and send documents)

Telecommuting Requirements:

• Ability to reputed company reputed company company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• Must live in a location that can receive a reputed company approved high-speed internet reputed company or reputed company an existing high-speed internet service.

Soft Skills:

• Written and verbal communications skills
• Ability to multi-task including the ability to understand multiple products and multiple levels of benefits reputed company each product
• Proven ability to work independently and deliver results under minimal supervision
• Ability to remain focused and productive each day though tasks may be repetitive
• reputed company employees working remotely will be required to adhere to reputed company’s Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $17.98 - $32.12 per hour based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups, and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes — an enterprise reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national reputed company, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Apply tot his job Apply To this Job