Medicare Advantage Appeals & Grievances Specialist

Blue Cross and Blue Shield of Kansas; Topeka (KS); Remoto; USD 52.000 - 76.000; Tempo pieno

Vantaggi offerti da questo lavoro

Health Insurance

Vision Insurance

Dental Insurance

Parental Leave (6 weeks)

Fertility/Adoption support

Caregiver Leave (2 weeks)

401(k) matching 5%

Tuition Reimbursement

Wellness benefits

Descrizione del lavoro

Blue Cross and Blue Shield of Kansas is seeking a MA Appeals and Grievances Specialist to ensure accurate processing and resolution of Medicare Advantage appeals and grievances. The role may involve handling inquiries from members, providers and representatives via telephone, email, and written correspondence.

The position supports a flexible work arrangement with remote or onsite options. Candidates residing in Kansas or Missouri or willing to relocate are encouraged to apply.

Competenze

• High school diploma or equivalent required.
• College courses in communications and/or medical fields preferred.
• Minimum 2 years customer service experience required.
• Minimum 3 years MA or Medicaid Appeals and Grievances experience.
• Minimum 2 years MA or other call center experience advisable.
• Previous Blue Plan experience preferred.

Mansioni

• Process MA member, member representative or provider appeals and grievances.
• Interpret MA benefit offerings and regulatory guidance to resolve issues.
• Prioritize work to meet internal and regulatory goals in a dynamic environment.
• Collaborate with internal/external contacts to resolve cases.
• Serve as backup to MA Customer Experience Representatives as needed.
• Complete special projects related to appeals, grievances or related responsibilities.

Conoscenze

Customer service

MA Appeals

Regulatory knowledge

Call center experience

Formazione

High school diploma or equivalent

College courses in communications/medical fields

Descrizione del lavoro

Blue Cross and Blue Shield of Kansas is seeking a MA Appeals and Grievances Specialist to ensure accurate processing and resolution of Medicare Advantage appeals and grievances. The role may involve handling inquiries from members, providers and representatives via telephone, email, and written correspondence.

The position supports a flexible work arrangement with remote or onsite options. Candidates residing in Kansas or Missouri or willing to relocate are encouraged to apply.