Medicaid Appeals Specialist: Resolve Claims & Grievances

UnitedHealth Group; United States; A distancia; USD 21.000 - 44.000; Jornada completa

Descripción de la vacante

Molina Healthcare is seeking a Claims Appeals Specialist to support claims activities, review member and provider complaints, and communicate resolutions in line with CMS standards.

You will research appeals and grievances, request and review medical records, prepare summaries, and ensure timely responses while applying contract language and benefits rules. A customer-focused professional with Medicare/Medicaid experience excels here.

Formación

• At least 2 years of managed care experience in appeals/claims environment.
• Experience with Medicaid and Medicare claims denials and appeals processing.
• Health claims processing experience including COB, subrogation, and eligibility.
• Customer service experience.
• Strong organizational and time-management skills.
• Effective verbal and written communication skills.
• MS Office proficiency.

Responsabilidades

• Research appeals and grievances to meet internal and regulatory timelines.
• Review medical records and bills to determine outcomes.
• Prepare appeal summaries and correspondence.
• Contact members/providers as needed.
• Identify root causes of payment errors and address them.
• Comply with CMS and regulatory guidelines.

Conocimientos

Customer service

Time management

Verbal & written communication

Microsoft Office

Herramientas

Microsoft Office

Descripción del empleo

Molina Healthcare is seeking a Claims Appeals Specialist to support claims activities, review member and provider complaints, and communicate resolutions in line with CMS standards.

You will research appeals and grievances, request and review medical records, prepare summaries, and ensure timely responses while applying contract language and benefits rules. A customer-focused professional with Medicare/Medicaid experience excels here.