Appeals Representative

Job Summary

Working remotely on a full-time basis, the Appeals Representative will research and resolve consumer and provider complaints, ensure proper categorization of complaints, and communicate decisions within required timeframes.

Key responsibilities:

• Research and resolve written complaints submitted by consumers and providers
• Ensure complaints are categorized correctly and obtain necessary documentation for case review
• Render decisions for non-clinical complaints and document final appeals or grievance determinations

Required qualifications:

• High School Diploma / GED or equivalent work experience
• At least 1 year of experience analyzing and solving customer problems
• 1+ years of experience working in a remote environment
• Proficiency with computer applications, including Microsoft Word and Outlook
• Ability to work between the hours of 7:00 am - 5:00 pm MST, Monday - Friday