Appeals Representative

Job Summary

Working remotely on a full-time basis, the Appeals Representative will research and resolve written complaints from consumers and providers, ensuring accurate categorization and documentation of cases while communicating decisions within required timeframes.

Key responsibilities

• Research and resolve written complaints submitted by consumers and physicians/providers
• Obtain additional documentation for case review and determine if clinician review is necessary
• Document final appeals or grievance determinations using appropriate templates and communicate outcomes effectively

Required qualifications

• High School Diploma / GED or equivalent work experience
• Must be 18 years of age or older
• 1+ years of experience in analyzing and solving customer problems
• 1+ years of experience working in a remote environment
• Proficiency with computer applications, including Microsoft Word and Outlook