Medicare Advantage Appeals & Grievances Specialist — Remote

Blue Cross and Blue Shield of Kansas; Missouri; Remote; USD 79,154,000 - 93,985,000; Full time

Benefits offered by this job

Incentive pay program (EPIP)

Health/Vision/Dental insurance

6 weeks paid parental leave for new-­m

Fertility/Adoption assistance

2 weeks paid caregiver leave

401(k) plan matching up to 5%

Tuition reimbursement

Health & fitness benefits, discounts

Job summary

Blue Cross and Blue Shield of Kansas is seeking a MA Appeals and Grievances Specialist to process and resolve Medicare Advantage appeals and grievances, interfacing with members, providers, and plan staff. You will ensure regulatory guidelines are met while delivering exceptional customer service.

This role supports remote or onsite work, with eligibility for candidates residing in Kansas or Missouri or willing to relocate as a condition of employment.

Qualifications

• High school diploma or equivalent required.
• College or continuing education courses in communications and/or medical related fields preferred.

Responsibilities

• Process MA member, member representative or provider appeals and grievances to ensure regulatory guidelines are met.
• Interpret and apply MA benefits, policies and procedures to address diverse issues.
• Manage time to prioritize work in a fluctuating environment and meet deadlines.
• Collaborate with internal/external contacts to resolve complex cases.
• Develop working relationships with staff, Plans, CMS caseworkers and providers for accurate resolution.
• Serve as backup to MA Customer Experience Representatives as needed.
• Complete special projects related to appeals, grievances or other responsibilities.

Skills

Empathy

Active listening

Research skills

Analytical thinking

Discretion

Team collaboration

Communication

Time management

Education

High school diploma

Communications courses preferred

Tools

None

Job description

Blue Cross and Blue Shield of Kansas is seeking a MA Appeals and Grievances Specialist to process and resolve Medicare Advantage appeals and grievances, interfacing with members, providers, and plan staff. You will ensure regulatory guidelines are met while delivering exceptional customer service.

This role supports remote or onsite work, with eligibility for candidates residing in Kansas or Missouri or willing to relocate as a condition of employment.