Remote Specialist Appeals and Grievances Nurses in Long Beach

Location: California

Compensation: To Be Discussed

Staff Reviewed: Sat, Oct 17, 2020

This job expires in 18 days

Job Category: Customer Service, Healthcare

Remote Level: 100% Remote

Employer Type: Employer

Career Level: Experienced

Job Summary

A healthcare company is in need of a Remote Specialist Appeals and Grievances Nurses in Long Beach.

Candidates will be responsible for the following:

  • Leading, organizing and directing the activities of the grievance and appeals Unit
  • Reviewing and resolving member complaints
  • Communicating resolution to members or authorized representatives

Applicants must meet the following qualifications:

  • Completion of an accredited LVN or LPN training program
  • Min. 1 year utilization review experience
  • 1 year managed care experience
  • Claims processing background, including coordination of benefits, subrogation, and eligibility criteria
  • Familiarity with Medicaid and Medicare claims denials and appeals processing