Medicare Appeals & Grievances Case Specialist - Hybrid

The Jacobson Group; Rhode Island; Hybrid; USD 29,000 - 40,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) retirement savings plan

Job summary

The Jacobson Group in Rhode Island is seeking a Case Specialist, Grievance and Appeals to join our team on a hybrid basis. You will investigate and resolve member and provider complaints, manage benefits and administrative appeals, and educate members about their plans.

This role requires 4+ years in appeals and grievances within managed care, Medicare experience, and strong written and verbal communication.

Qualifications

• 4+ years in appeals and grievances within a managed care environment.
• Must reside within a commutable distance to Rhode Island and be willing to come into the office as needed.
• Medicare experience with appeals and grievances, customer service or claims.
• Strong written and verbal communication skills.

Responsibilities

• Investigate and resolve member and provider complaints, benefits appeals, and administrative appeals.
• Maintain detailed documentation of cases and follow up as necessary.
• Respond to inquiries via telephone and written communication, providing clear and accurate information.
• Educate members to improve their understanding of their healthcare plans.
• Identify and elevate potential quality of care issues for review.
• Collaborate with internal departments to analyze trends, identify root causes for appeals, and suggest procedural or policy changes.
• Prepare for departmental audits in anticipation of regulatory site visits.

Skills

Grievance handling

Appeals process

Medicare experience

Strong communication

Job description

The Jacobson Group in Rhode Island is seeking a Case Specialist, Grievance and Appeals to join our team on a hybrid basis. You will investigate and resolve member and provider complaints, manage benefits and administrative appeals, and educate members about their plans.

This role requires 4+ years in appeals and grievances within managed care, Medicare experience, and strong written and verbal communication.