Appeals Representative

Job Summary

Working remotely in a full-time capacity, the Appeals Representative will research and resolve written complaints from consumers and providers, ensuring proper 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 required for case review and determine if clinician review is necessary
• Render decisions for non-clinical complaints and communicate appeal or grievance information to relevant parties

Required qualifications

• High School Diploma / GED or equivalent work experience
• 1+ years of experience analyzing and solving customer problems
• 1+ years of experience working in a remote environment
• Proficiency with computer systems, Microsoft Word, and Microsoft Outlook
• Ability to work full-time, Monday - Friday, with flexibility for 8-hour shifts