Data Entry Specialist- REMOTE

TEKsystems, Inc.; Miami (FL); Remote; Full time

Job summary

A leading company in technology services seeks Data Entry Representatives to manage appeals and grievances. This fully remote role requires strong analytical and communication skills to ensure compliance with regulations while addressing member and provider needs. Candidates should have at least three years of relevant experience, particularly in the health industry, to excel in this fast-paced environment.

Benefits

Medical benefits

Dental insurance

Vision insurance

401(k)

Paid time off (PTO)

Life insurance

Transportation benefits

Qualifications

• 3+ years of experience, preferably in a compliance environment.
• Excellent verbal and written communication skills required.
• Proficiency in MS Office applications.

Responsibilities

• Review and evaluate appeal and grievance requests.
• Investigate member and provider correspondence.
• Ensure timely resolution of claims and disputes.

Skills

Communication

Problem-solving

Analytical skills

Time management

Education

3+ years of related professional experience

Experience in health industry and/or compliance

Tools

MS Office

Job description

Description

REMOTE

SHIFT: Mon - Friday, 9am - 5pm

POSITION OVERVIEW:

Client has a backlog of 10,000 appeals and grievances. Data Entry Reps will filter through appeals and take the following actions:

Summary of Position:

Respond to written/verbal grievances, complaints, appeals, and disputes submitted by members and providers in accordance with NCQA, CMS, State, and other regulations.

Process appeals and grievances to facilitate the accurate administration of benefits and clinical policy; ensure compliance with all regulatory requirements and NCQA standards.

Work as an effective interface between internal and external customers.

Maintain good member and provider relations.

Principal Accountabilities:

• Review and evaluate appeal and grievance requests to identify and classify member and provider appeals.
• Determine eligibility, benefits, and prior activity related to the claims, payment, or service in question.
• Provide written acknowledgment of member and provider correspondence.
• Make verbal contact with members or authorized representatives during research to clarify issues.
• Investigate member and provider correspondence by analyzing issues and obtaining responses from internal and external entities.
• Serve as liaison with departments, delegated entities, medical groups, and network physicians to ensure timely resolution.
• Research appeal files for completeness and accuracy; consult with legal and other internal areas as needed.
• Prepare cases for medical and administrative review, detailing findings for determinations.
• Monitor pending reports and worklists to meet internal and regulatory timeframes.
• Monitor resolution outcomes from appeals and reviews.
• Identify areas for improvement and provide feedback to management.
• Prepare responses to member and provider correspondence addressing issues accurately.
• Ensure documentation meets requirements; create service requests and track issues; document resolutions for reporting.

Additional Skills & Qualifications

• 3+ years of related professional experience.
• Experience in health industry and/or compliance.
• Excellent verbal and written communication skills.
• Experience in managed care or compliance environment.
• Proficiency in MS Office applications.
• Strong problem-solving and analytical skills.
• Ability to work under pressure and deliver accurate results.
• Excellent organization and time management skills.

Experience Level: Intermediate

Pay and Benefits:

The pay range is $20.00/hr. Benefits may include medical, dental, vision, 401(k), life insurance, disability, HSA, transportation, EAP, and PTO. Eligibility depends on job classification and employment length.

Workplace Type: Fully remote

Application Deadline: Jul 8, 2025

About TEKsystems:

TEKsystems helps clients activate ideas and solutions across North America, Europe, and Asia. We are a leader in Full-Stack Technology Services and Talent Services, working with many Fortune 500 companies. TEKsystems is part of Allegis Group.

We are an equal opportunity employer and consider all applications without regard to race, sex, age, or other protected characteristics.