Medicare Appeals & Grievances Advocate Customer Experience

Blue Cross and Blue Shield of Kansas; Missouri; Remote; USD 38,000 - 45,000; Full time

Benefits offered by this job

Health insurance

6 weeks parental leave

401(k) match up to 5%

Tuition reimbursement

Fertility/adoption assistance

Job summary

Blue Cross and Blue Shield of Kansas is seeking an MA Appeals and Grievances Specialist to improve member experiences and ensure compliant resolutions. The role involves processing MA appeals, answering inquiries, and collaborating with CMS, providers, and plans.

Qualification includes 2+ years in customer service and 3+ years in MA/Medicaid appeals. Remote or onsite work is available under our Telecommuting Policy, with relocation to Kansas/Missouri supported.

Qualifications

• Minimum 2 years' experience in customer service.
• Minimum 3 years' MA or Medicaid Appeals and Grievances experience.
• Minimum 2 years' experience in MA or other call center/customer service preferred.
• Previous experience with Blue Plan preferred.

Responsibilities

• Process MA member, member representative or provider appeals and grievances ensuring regulatory compliance.
• Interpret MA benefit offerings and relevant policies to resolve issues.
• Manage time to prioritize work and meet regulatory and internal goals.
• Collaborate with internal/external contacts to resolve complex cases.
• Build relationships with staff, plans, CMS, providers and members for timely resolutions.
• Serve as back-up to MA Customer Experience Representatives as needed.

Skills

Empathy

Communication

Research

Analytical thinking

Time management

Team collaboration

Telephone/Email handling

Documentation

Education

High school diploma or equivalent

Communications/medical coursework

Tools

CMS systems

Job description

Blue Cross and Blue Shield of Kansas is seeking an MA Appeals and Grievances Specialist to improve member experiences and ensure compliant resolutions. The role involves processing MA appeals, answering inquiries, and collaborating with CMS, providers, and plans.

Qualification includes 2+ years in customer service and 3+ years in MA/Medicaid appeals. Remote or onsite work is available under our Telecommuting Policy, with relocation to Kansas/Missouri supported.